Compliance Program Administrator

St. Jude Children's Research Hospital•Memphis, TN

About The Position

We are seeking a highly skilled and detail-oriented Compliance Program Administrator with a strong background in hospital billing compliance to join our Healthcare Compliance team. The ideal candidate will have at least five (5) years of experience in hospital billing compliance, with in-depth knowledge of Medicaid Recovery Audit Contractor (RAC) processes, payer guidelines, and the regulatory frameworks governing healthcare reimbursement. 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.

Requirements

Bachelor’s degree in a relevant field is required.
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.
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.

Nice To Haves

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)

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.
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.