Compliance Program Administrator bei St. Jude Children's Research Hospital
St. Jude Children's Research Hospital · Memphis, Vereinigte Staaten Von Amerika · Onsite
- Professional
- Optionales Büro in Memphis
This role plays a critical part in ensuring that our institution maintains full compliance with federal and state regulations, payer requirements, and internal policies related to billing, coding, and documentation.
Job 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.
Minimum Education and/or Training
Bachelor’s degree in a relevant field is required.
Minimum Experience
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.
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
(LC: RN-TN) Must possess a current Tennessee State Board of Nursing license if the primary residence is Tennessee or a non-Compact state.
(LC: RN-ARK or RN-MISS) Must possess a current State Board of Nursing license in the state of primary residence if the state is a Nurse Licensure Compact state.
(LC: NBCRNA) Certification by the National Board of Certification and Recertification of Nurse Anesthetists.
(LC: APN-TN) Must possess a current Advanced Practice Nurse License issued by the Tennessee State Board of Nursing.
(LC: PHARM-TN) Licensure by the Tennessee State Board of Pharmacy.
(LC: PTCB-PTECH) Pharmacy Technician Certification by the Pharmacy Technician Certification Board (PTCB).
Special Skills, Knowledge, and Abilities
Proactively engages with internal and external customers to seek feedback and deliver high-quality service.
Develops and implements new approaches to improve compliance systems and processes.
Independently identifies and addresses complex compliance and customer needs.
Leads team meetings and effectively communicates with cross-functional teams to achieve results.
Demonstrates proficiency with digital communication tools.
Actively participates in meetings, raising concerns and sharing insights.
Analyzes data effectively to identify trends and root causes of compliance issues.
Solves problems quickly and strategically by leveraging data and insights.
Encourages adaptability and optimism during periods of change, focusing on long-term goals and solutions.
Maintains composure and professionalism in challenging or uncertain situations.
Leads and motivates teams to drive engagement, ownership, and delivery of compliance objectives.
Facilitates planning and implementation of complex compliance program elements (e.g., governance, auditing, continuous improvement) to achieve measurable outcomes.
Provides actionable, strategic advice to stakeholders by breaking down complex compliance challenges.
Demonstrates comprehensive knowledge of current regulations and standards within their domain and their broader institutional implications.
Monitors and promotes compliance processes across teams, identifying gaps and implementing corrective measures.
Investigates and addresses deviations or compliance issues within assigned areas.
Physical Demands and Working Conditions
The physical demands described here are representative of those required of an employee to perform the essential functions of this job successfully.
Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.
While performing the duties of this job, the employee is regularly required to stand, walk, sit, kneel, use hands to finger, handle, or feel, and talk or hear.
The employee must occasionally lift and/or move up to 25 pounds.
Specific vision abilities required include close vision, depth perception, and the ability to adjust focus.
The employee must move about the workspace to access work surfaces, shelves, cabinets, drawers, and equipment located at, below, or above the work surface.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
The noise level in the work environment is usually quiet.
An essential function of this position is compliance with all applicable federal, state, and local safety and health regulations.
Nothing in this job description limits management’s right to assign or reassign duties and responsibilities to this position at any time as business needs dictate. This job description reflects management’s assignment of essential functions; it does not prescribe or restrict tasks that may be assigned. The information contained herein is not intended to be an all-inclusive list of the duties, responsibilities, skills, or abilities required to perform this job.
Compensation
In recognition of certain U.S. state and municipal pay transparency laws, St. Jude is including a reasonable estimate of the compensation range for this role. This is an estimate offered in good faith and a specific salary offer takes into account factors that are considered in making compensation decisions including but not limited to skill sets, experience and training, licensure and certifications, and other business and organizational needs. It is not typical for an individual to be hired at or near the top of the salary range and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current salary range is $86,320 - $154,960 per year for the role of Compliance Program Administrator.Explore our exceptional benefits!
No Search Firms
St. Jude Children's Research Hospital does not accept unsolicited assistance from search firms for employment opportunities. Please do not call or email. All resumes submitted by search firms to any employee or other representative at St. Jude via email, the internet or in any form and/or method without a valid written search agreement in place and approved by HR will result in no fee being paid in the event the candidate is hired by St. Jude.
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