Manager, Healthcare Compliance - Disputes, Claims & Investigations

At Stout, we're dedicated to exceeding expectations in all we do - we call it Relentless Excellence. Both our client service and culture are second to none, stemming from our firmwide embrace of our core values: Positive and Team-Oriented, Accountable, Committed, Relationship-Focused, Super-Responsive, and being Great communicators. Sound like a place you can grow and succeed? Read on to learn more about an exciting opportunity to join our team. Impact You'll Make As a Healthcare Compliance Manager, you will help healthcare organizations design, implement, and maintain effective compliance programs across physician practice groups, clinical laboratories, and pharmacy operations. Lead compliance program rollout across multi-site healthcare operations. Develop risk-based audit plans, monitoring activities, and gap analyses. Translate regulatory and payer requirements into practical controls, training, and corrective action plans. Partner with operational, clinical, revenue cycle, quality, HR, IT/security, legal, and finance teams. Strengthen compliance culture through clear reporting, education, and remediation support. What You'll Do Lead the rollout and refresh of compliance plans, policies, SOPs, controls, training, monitoring cadence, and escalation processes. Build standardized compliance tools, including gap assessment templates, control matrices, readiness checklists, training plans, and CAP trackers. Conduct periodic compliance risk assessments and develop annual audit and monitoring workplans. Monitor enforcement trends, payer focus areas, and regulatory updates to adjust compliance priorities. Design and execute audits, monitoring activities, and gap analyses across physician practice, laboratory, and pharmacy operations. Prepare audit reports with risk ratings, root-cause analysis, financial or operational impact, and recommendations. Develop, track, and validate corrective action plans through follow-up testing and closure. Lead or oversee audits of professional services documentation, coding, billing, modifiers, and medical necessity. Partner with revenue cycle and coding teams to identify trends, reduce repeat findings, and support payer audits. Support lab compliance activities related to CLIA, CAP, Joint Commission readiness, document control, SOP governance, quality audits, and CAPA processes. Develop and maintain pharmacy compliance program components related to policy governance, regulatory change monitoring, controlled substances, audits, and inspection readiness. Support investigations into compliance concerns and coordinate with HR and legal as needed. Build and deliver role-based compliance training for providers, billing and coding teams, lab personnel, pharmacy staff, and managers. Maintain compliance dashboards covering audit activity, findings, CAP aging, training completion, and trends. Prepare recurring updates for leadership and compliance committees. What You Bring Bachelor's degree in healthcare administration, nursing, business, public health, health information management, or a related field, or equivalent experience. CHC certification required; equivalent healthcare compliance certification may be considered. 7+ years of progressive healthcare compliance experience. Demonstrated experience owning compliance program rollout, risk-based audit planning, auditing and monitoring, gap analysis, corrective action development, and validation. Experience supporting compliance across large physician practice groups, clinical laboratory operations, and pharmacy operations. Strong understanding of documentation, coding, billing, medical necessity, CLIA/CAP readiness, pharmacy regulatory requirements, DEA requirements, and state board requirements. Strong report writing, presentation, and stakeholder management skills. Ability to communicate sensitive findings professionally and influence remediation owners. Additional credentials such as CPC, CCS, CPMA, CHPC, CTP, or other relevant certifications preferred. Experience managing payer or vendor audits and reporting status to senior leadership preferred. Experience with analytics, dashboards, audit management tools, or data warehouse reporting preferred. Prior leadership or supervisory experience preferred. How You'll Thrive Apply strong audit fundamentals, including scoping, sampling, evidence standards, workpapers, issue classification, CAP design, and re-testing. Translate regulatory and payer requirements into practical workflows and controls. Build trust with clinical, operational, legal, revenue cycle, quality, HR, IT/security, and finance stakeholders. Manage sensitive issues with discretion, professionalism, and sound judgment. Communicate findings clearly to leadership and compliance committees. Balance multiple priorities while maintaining accuracy and follow-through. Support a speak‑up culture, consistent non‑retaliation practices, and sustained compliance improvement. Deliver Relentless Excellence through practical guidance, responsive service, and strong execution. Why Stout? At Stout, we offer a comprehensive Total Rewards program with competitive compensation, benefits, and wellness options tailored to support employees at every stage of life. We foster a culture of inclusion and respect, embracing diverse perspectives and experiences to drive innovation and success. Our leadership is committed to inclusion and belonging across the organization and in the communities we serve. We invest in professional growth through ongoing training, mentorship, employee resource groups, and clear performance feedback, ensuring our employees are supported in achieving their career goals. Stout provides flexible work schedules and a discretionary time off policy to promote work‑life balance and help employees lead fulfilling lives. Learn more about our benefits and commitment to your success. The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria necessary to successfully perform the job. Stout is an Equal Employment Opportunity. All qualified applicants will receive consideration for employment on the basis of valid job requirements, qualifications and merit without regard to race, color, religion, sex, national origin, disability, age, protected veteran status or any other characteristic protected by applicable local, state or federal law. Stout is required by applicable state and local laws to include a reasonable estimate of the compensation range for this role. The range for this role considers several factors including but not limited to prior work and industry experience, education level, and unique skills. The disclosed range estimate has not been adjusted for any applicable geographic differential associated with the location at which the position may be filled. It is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $87,000.00 - $195,000.00 Annual. This role is also anticipated to be eligible to participate in an annual bonus plan. Information about benefits can be found here - #J-18808-Ljbffr Stout