Stout
Manager, Healthcare Compliance - Disputes, Claims & Investigations
Chicago, IL, United States of America
Sponsorship not specified$87k-$195kDetected 37 days ago
ComplianceStakeholder ManagementAuditingCadencePublic HealthClinical Laboratory TechniquesLeadershipMentoring
About the role
- 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.
Responsibilities
- 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.
- Design and execute audits, monitoring activities, and gap analyses across physician practice, laboratory, and pharmacy operations.
- Develop, track, and validate corrective action plans through follow-up testing and closure.
- 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.
Requirements
- CHC certification required
- 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.
- Ability to communicate sensitive findings professionally and influence remediation owners.
- Bachelor's degree in healthcare administration, nursing, business, public health, health information management, or a related field, or equivalent experience.
- equivalent healthcare compliance certification may be considered.
- 7+ years of progressive healthcare compliance experience.
- 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.
- How You'll Thrive
Nice to have
- 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.
Compensation
- Conduct periodic compliance risk assessments and develop annual audit and monitoring workplans.
Benefits
- Lead or oversee audits of professional services documentation, coding, billing, modifiers, and medical necessity.
- Lead compliance program rollout across multi-site healthcare operations.
- Strengthen compliance culture through clear reporting, education, and remediation support.
- CHC certification required; equivalent healthcare compliance certification may be considered.
This listing is sourced directly from Stout's careers page and normalized into a canonical job model.