Latino Memphis · 12 hours ago
Compliance Program Administrator
Memphis, TN
Full-time
Onsite
Senior Level
5+ years expSt. Jude Children's Research Hospital is seeking a highly skilled and detail-oriented Compliance Program Administrator to join their Healthcare Compliance team. The role is crucial in ensuring compliance with federal and state regulations, payer requirements, and internal policies related to hospital billing and coding.
Non-profit Organization Management
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
Required
At least five (5) years of experience in hospital billing compliance
In-depth knowledge of Medicaid Recovery Audit Contractor (RAC) processes, payer guidelines, and the regulatory frameworks governing healthcare reimbursement
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 required
Demonstrated record of success and proven performance in previous compliance roles
Bachelor's degree in a relevant field is required
Preferred
Independent and experienced in the hospital billing space
Strong knowledge of Medicaid and payer guidelines
Background in clinical research billing
Experience in billing compliance
Certified Professional Coder (CPC)
Certified Compliance Specialist (CCS)
Licensure, Registration, and/or Certification Required by SJCRH Only One of the following licenses or certifications must be obtained within two (2) years of employment: RHIA: Registered Health Information Administrator, CHC: Certified in Healthcare Compliance, CHRC: Certification in Healthcare Research Compliance, CHPC: Certification in Healthcare Privacy Compliance, CCEP / CCEP-I: Certified Compliance & Ethics Professional / Certified Compliance & Ethics Professional – International, CCS: Certified Compliance Specialist, CPCO: Certified Professional Compliance Officer, CCP: Certified Compliance Professional, CIPP: Certified Information Privacy Professional, CQA: Certified Quality Auditor, CQE: Certified Quality Engineer, CIA: Certified Internal Auditor
Must possess a current Tennessee State Board of Nursing license if the primary residence is Tennessee or a non-Compact state
Must possess a current State Board of Nursing license in the state of primary residence if the state is a Nurse Licensure Compact state
Certification by the National Board of Certification and Recertification of Nurse Anesthetists
Must possess a current Advanced Practice Nurse License issued by the Tennessee State Board of Nursing
Licensure by the Tennessee State Board of Pharmacy
Pharmacy Technician Certification by the Pharmacy Technician Certification Board (PTCB)
Company
Latino Memphis
For many Latinos living in Memphis, Latino Memphis is the first step in their pursuit of a better life for themselves and their families.
11-50 employees
Funding
Current Stage
Early StageLeadership Team
Mauricio Calvo
Chief Executive Officer
Cynthia Magallon Puljic
Chief Operating & Chief Financial Officer
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