Aeroflow Health - Head of Audit and Compliance (Vice President)The OpportunityThe Head of Audit and Compliance leads Aeroflow Health's healthcare compliance and audit programs across its business units and applicable subsidiaries. This role develops practical controls to support compliant operations, accurate billing, and readiness for payer and regulatory review. Reporting directly to the General Counsel, the leader oversees internal compliance audits, external payer audit responses, compliance investigations, and corrective action, and provides candid reporting on material risks and program effectiveness.
Your Primary ResponsibilitiesEssential responsibilities
- Compliance program leadership
- Establish and maintain a risk-based compliance program, including policies, training, reporting channels, investigations, monitoring, and consistent accountability.
- Lead an annual enterprise healthcare compliance risk assessment and maintain an audit and compliance work plan that addresses emerging risks and business priorities.
- Advise business leaders on compliance requirements affecting DME, telehealth, patient education, and other healthcare services, in partnership with Legal and clinical leadership.
- Coordinate oversight of billing integrity, documentation, medical necessity, ordering and referring provider requirements, credentialing and enrollment, exclusions screening, and fraud, waste, and abuse controls.
- Employee has an individual responsibility for knowledge of and compliance with laws, regulations, and policies.
- Compliance is a condition of employment and is considered an element of job performance.
- Maintain HIPAA/patient confidentiality.
Internal audits and external payer reviews
- Direct internal reviews of claims, patient records, orders, authorizations, proof of delivery, and related operational controls across Medicare, Medicaid, and commercial payer programs.
- Lead responses to prepayment and postpayment audits, documentation requests, and corrective action requirements; maintain centralized tracking of deadlines, findings, denials, and outcomes.
- Partner with Legal, Revenue Cycle, clinical teams, and outside advisors on appeal support, disputed findings, repayment analyses, and audit strategy.
- Ensure audit findings identify root causes and practical remediation, with accountable owners, completion dates, and follow-up testing to verify effectiveness.
Investigations and risk escalation
- Oversee the compliance reporting process and investigate suspected misconduct, billing concerns, and policy violations, coordinating with Legal, HR, and the Privacy Officer as appropriate.
- Promptly escalate potential overpayments, systemic billing issues, fraud concerns, and significant control failures to the General Counsel; support investigation and resolution within applicable deadlines.
- Maintain complete and objective audit and investigation records; follow Legal's direction on matters conducted under counsel.
Leadership and reporting
- Lead, coach, and develop audit and compliance personnel; manage priorities, resources, and external
- support within the approved budget.
- Present clear risk reports and dashboards to the General Counsel and leadership, and to the board or an
- appropriate committee as authorized or required by the Company's governance structure.
- Partner with the Privacy Officer on shared risks while retaining responsibility for healthcare compliance
- and payer audit oversight; support compliance integration for acquisitions and new services.
Required Qualifications- Bachelor's degree in healthcare administration, business, accounting, nursing, or a related field, or an equivalent combination of relevant education and experience.
- At least eight years of progressive healthcare compliance, audit, reimbursement, or regulatory experience, including at least three years leading a team or a significant enterprise program.
- Substantial experience with Medicare, Medicaid, and commercial payer requirements, healthcare billing and documentation audits, external payer reviews, and corrective action.
- Working knowledge of healthcare fraud and abuse requirements, including the False Claims Act, Anti-Kickback Statute, and applicable state requirements; ability to identify issues requiring legal advice.
- Demonstrated ability to conduct sensitive investigations, analyze claims and operational data, communicate findings clearly, and influence leaders across business functions.
You might also have- Juris Doctor strongly preferred
- Experience with DME suppliers, multistate healthcare operations, telehealth, or patient education programs.
- Certified in Healthcare Compliance (CHC)
- Experience improving audit workflows, implementing compliance dashboards, and supporting acquisitions or rapidly growing healthcare organizations.
What Aeroflow OffersCompetitive Pay, Health Plans with FSA or HSA options, Dental, and Vision Insurance, Optional Life Insurance, 401K with Company Match, 12 weeks of parental leave for birthing parent/ 4 weeks leave for non-birthing parent(s), Additional Parental benefits to include fertility stipends, free diapers, breast pump, Paid Holidays, PTO Accrual from day one, Employee Assistance Programs and SO MUCH MORE!!
