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St. Jude Children's Research Hospital · 1 day ago

Compliance Program Administrator

Memphis, TN

Full-time

Onsite

Mid, Senior Level

$86K/yr - $155K/yr

5+ years exp

St. Jude Children's Research Hospital is seeking a highly skilled and detail-oriented Compliance Program Administrator to join their Healthcare Compliance team. This role plays a critical part in ensuring that the institution maintains full compliance with federal and state regulations, payer requirements, and internal policies related to billing, coding, and documentation.

BiotechnologyCharityHealth CareHealth DiagnosticsHospitalMedicalNon Profit

Growth Opportunities

Responsibilities

Lead and manage the hospital billing compliance program across inpatient and outpatient services

Perform risk-based evaluations of internal and external compliance trends to inform program focus areas

Monitor and interpret Medicaid Recovery Audit Contractor (RAC) activity, including appeals and corrective actions

Ensure adherence to payer-specific guidelines, including Medicare, Medicaid, and commercial payers. Experience with clinical research billing guidelines is preferred

Conduct internal audits, monitor activities, and risk assessments to identify billing and coding discrepancies

Collaborate with Revenue Cycle, Revenue Integrity, Health Information Management Services (HIMS), and clinical departments to resolve compliance issues

Establish and maintain a role as a trusted partner and subject matter expert with key stakeholders and compliance collaborators

Develop and deliver training programs on billing compliance, RAC audits, and payer regulations

Maintain current knowledge of CPT, HCPCS, ICD-10, and other coding standards

Prepare and present compliance reports to senior leadership

Support responses to external audits and regulatory inquiries

Assist in policy development and updates based on regulatory changes and institutional needs

Support other strategic and operational initiatives of the Compliance Office

Qualification

Hospital billing complianceMedicaid RAC processesPayer guidelinesCompliance program managementCertified Professional Coder (CPC)Certified Compliance Specialist (CCS)Clinical research billingRisk assessmentData analysisCommunication skillsProblem-solving

Required

At least five (5) years of experience in hospital billing compliance

In-depth knowledge of Medicaid Recovery Audit Contractor (RAC) processes

Knowledge of payer guidelines and the regulatory frameworks governing healthcare reimbursement

Bachelor's degree in a relevant field

Minimum of five (5) years of directly applicable compliance experience (e.g., governance, auditing and monitoring, training, risk assessment, investigation of compliance concerns, and action recommendations)

Prior compliance program management experience

Demonstrated record of success and proven performance in previous compliance roles

One of the following licenses or certifications must be obtained within two (2) years of employment: RHIA, CHC, CHRC, CHPC, CCEP / CCEP-I, CCS, CPCO, CCP, CIPP, CQA, CQE, CIA, (LC: RN-TN), (LC: RN-ARK or RN-MISS), (LC: NBCRNA), (LC: APN-TN), (LC: PHARM-TN), (LC: PTCB-PTECH)