Compliance Manager, Audit and Oversight

Company overview: Lumina Care Lumina is focused on unifying, coordinating, and managing care for geriatric patients in nursing facilities and at home. We offer a range of services to improve health outcomes and quality of life for patients, including after-hours telehealth, transitional care, chronic care, remote patient monitoring, behavioral health, and telehealth psychiatry. Job title: Compliance Manager, Audit and Oversight Purpose/Summary: The Compliance Manager is responsible for the development, implementation, and management of Lumina Care’s clinical compliance audit and monitoring program. This role ensures that clinical documentation, coding, and billing practices comply with federal and state regulations as well as payer and accreditation standards. The manager works under the direction of the VP, Compliance and Privacy and collaborates with clinical, billing, legal, and operations teams to identify compliance risks and drive continuous quality improvement in documentation quality and revenue integrity. Role & Core Responsibilities: Audit Program Development Execution and Oversight Program Management - Design, implement, and manage a risk-based internal audit and monitoring program that prospectively and retrospectively evaluates clinical documentation, coding, and billing standards. • Oversee audits conducted by vendors, payors, and regulators; ensure audit methodologies and findings are consistent with Lumina Care’s standards and requirements. • Maintain audit tracking tools and dashboards to monitor progress, outcomes, and corrective actions. Clinical Documentation, Coding, and Billing Compliance - Identify, analyze, and investigate billing, coding, and documentation errors, patterns, and root causes. • Lead corrective action planning and collaborate with clinical and operational teams to ensure timely resolution. • Serve as a subject matter expert on compliance requirements related to coding, billing, and revenue cycle processes. Corrective Actions Plans, Education, and Continuous Improvement - Develop and monitor corrective action plans (CAPs) to address audit findings or compliance deficiencies. • Collaborate with clinical and operations teams to validate remediation of corrective actions and consistently identify areas of opportunity to strengthen documentation and mature billing compliance processes. • Partner with clinical educators to develop and deliver targeted training based on audit findings and compliance trends. • Promote best practices in documentation and coding through education and regular communication with clinical staff. • Contribute to a culture of compliance, accuracy, and accountability across the organization. • Revise and/or refine compliance trainings based on trends and oversight findings. Policy, Regulatory, and Risk Integration - Monitor changes in healthcare regulations (OIG, CMS, HIPAA, payer rules) and integrate updates into compliance processes and policies. • Develop and maintain policies, procedures, and guidelines that support compliance audits and operational consistency. • Coordinate with Legal, Privacy, and Security teams on compliance risk mitigation strategies. Reporting and Analytics - Develop compliance metrics, dashboards, and executive reports to communicate key trends, risks, and program effectiveness. • Present findings and recommendations to the Compliance Committee and leadership to support data-driven decision-making. • Consistently and collaboratively communicate audit findings to the clinical teams. • Use data-driven analyses and techniques to develop and justify any audit work plans. Key Skills: • Strong understanding of clinical documentation, billing, and AMA coding guidelines. • Analytical mindset with the ability to identify trends and root causes. • Excellent communication and collaboration capabilities across various teams and levels. • Strong ability to interpret and apply complex regulatory and payer requirements. - Familiarity with HIPAA, CMS, OIG, and payer compliance requirements. The list of responsibilities is not exhaustive and may contain other duties as assigned. Qualifications: Experience: Minimum of seven (7) years’ experience in clinical coding, auditing, documentation improvement, or billing/coding compliance. Ability to review and interpret regulatory requirements. In-depth knowledge of professional/facility coding, billing, and healthcare revenue cycle. Firm grasp of treatment protocols, medical procedures, and healthcare practices. Education: Bachelor’s degree required, certification required (CPC, CPMA, and/or CDI) advanced degree preferred Working conditions Location: Remote Work Environment: Must have a secure, private home office or workspace to maintain HIPAA compliance and company data privacy and security standards. Physical Requirements: Sedentary work that may require up to 10lbs of lifting Schedule: Monday-Friday, with occasional evenings or weekends based on project or audit requirements Travel: Up to 10% for meetings, training, or on-site audits Compensation: Compensation is commensurate with experience, education, and qualifications. A competitive salary range will be provided during the hiring process. Lumina Care offers a comprehensive and competitive benefits package, including: • Medical, Dental, and Vision Insurance • Paid Time Off (PTO) • Paid Holidays and Floating Holidays • Flexible work arrangements (NYC) and remote work options Lumina Care is an Equal Opportunity Employer. We consider all qualified applicants for employment without regard to race, color, religion, sex, national origin, age, disability, genetic information, or any other characteristic protected by law. Reasonable accommodations are available to qualified individuals with disabilities throughout the application and employment process. Pay: $85,000.00 - $100,000.00 per year Benefits: • 401(k) • Dental insurance • Health insurance • Paid time off • Vision insurance • Work from home Education: • Bachelor's (Preferred) Experience: • auditing medical charts: 7 years (Required) License/Certification: • Certified Professional Coder (Preferred) • Certified Professional Medical Auditor (Preferred) Work Location: Remote Apply tot his job