Compliance Program Manager-Auditor & Educator
About the Job
The Compliance Program Manager-Auditor and Educator (CPM) is responsible for facilitating the implementation of the elements of an effective Compliance Program as outlined in Office of Inspector General (OIG) guidance(s) and United States Department of Justice (DOJ) Sentencing Guidelines. The CPM conducts independent risk-based internal auditing and monitoring, develops and provides compliance education and training, investigates reported compliance concerns, drafts policies and procedures, and serves as a subject matter expert and resource in the area of healthcare compliance. The CPM assists in the development and participates in the execution of the overarching Compliance Program Annual Work Plan and creates detailed critical reports for senior management.
The Compliance Program Manager- Auditor and Educator (CPM) responsibilities include:
- Conducts independent risk-based auditing and monitoring for compliance with third-party payer (e.g., Medicaid) and regulatory requirements.
- Investigates and manages reported compliance concerns.
- Develops and conducts or coordinates compliance training (e.g., fraud, waste and abuse; provider billing and coding; or home health compliance).
- Develops or recommends revisions to policies and procedures related to Medicaid or other Federal or State compliance requirements
- Serves as an expert resource on compliance or regulatory requirements.
- In collaboration with the COA develops and reports metrics that demonstrates the effectiveness of the Compliance Program.Stays abreast of rules, regulations and reimbursement issues impacting healthcare compliance requirements.
- Participates as assigned to various institutional compliance committees.
- Performs other related duties as assigned or directed to meet the goals and objectives of the department and the institution.
- Bachelor's Degree in healthcare, business administration or related field required.
- Graduate and/or advanced level training preferred
- Three (3) years experience in a healthcare (administration or delivery) related field required
- Prior corporate or healthcare compliance and auditing experience strongly preferred
- One or more of the following certifications preferred: RHIA, RHIT, CPC, CPC-H, CHC, CCS, CCS-P
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.