The Director of Internal Audits provides strategic oversight of the organization’s internal audit function, ensuring comprehensive, risk-based audit coverage and delivering independent, objective evaluations of governance, risk management, and internal control systems. This role owns the Internal Audit Work Plan and leads operational and regulatory compliance audits within a healthcare environment, aligning with federal and state requirements.
Provide leadership and oversight to ensure audit work is performed and documented in accordance with departmental standards and regulatory requirements.
Develop, own, and manage the Internal Audit Work Plan, including audit scope, frequency, sampling methodologies, and timelines.
Plan and execute audits aligned with Office of Inspector General (OIG) and Office of the Medicaid Inspector General (OMIG) work plans to ensure organizational compliance.
Assign audit activities, monitor progress against benchmarks, and ensure timely completion of audit deliverables.
Serve as the primary liaison between Internal Audit, executive leadership, division heads, and compliance stakeholders.
Collaborate with Compliance Officers to design and execute audits included in Compliance Work Plans.
Oversee medical record documentation audits to identify under-coded or up-coded services; review findings and communicate results to physicians for education and compliance awareness.
Prepare and present clear, timely audit reports for Executive Management, Compliance Officers, and the Chief Financial Officer.
Research, analyze, and respond to inquiries related to compliance, coding accuracy, denials, and billable services.
Partner with physicians, business offices, provider enrollment, managed care, informatics, and other departments to ensure accurate billing, documentation, and adherence to policies and regulations.
Design annual audit plans and conduct enterprise risk assessments; recommend corrective actions and monitor remediation.
Lead, mentor, and develop internal audit staff, fostering accountability, professional growth, and a continuous improvement culture.
Promote ethical practices, transparency, and audit readiness across the organization.
Stay current on regulatory and coding updates through conferences, workshops, and professional development activities.
Perform other related duties as assigned.
Strong leadership and team management capabilities.
In-depth knowledge of CPT codes and ICD-9/10 coding systems.
Thorough understanding of CMS guidelines and federal and state healthcare compliance regulations.
Knowledge of anatomy and medical terminology.
Strong analytical, interviewing, and investigative skills.
Ability to manage multiple priorities while maintaining confidentiality.
Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint).
Excellent written and verbal communication skills, including executive-level reporting.
