What are the responsibilities and job description for the Program Manager Revenue Integrity Compliance: Corporate Compliance position at Hoag Health System?
Job Description
Primary Duties and Responsibilities
The Program Manager Revenue Integrity Compliance supports implementation of the Revenue Integrity Compliance Program for Hoag Memorial Hospital Presbyterian and its affiliated companies (collectively “Hoag”). The Program Manager Revenue Integrity Compliance is a key corporate compliance role providing onsite support of billing, coding and revenue cycle compliance related matters for Hoag enterprise-wide. Possesses working knowledge of revenue cycle operations, regulatory and compliance rules and regulations, various payer reimbursement practices and government billing audits.
In collaboration with the Sr. Principal, Revenue Integrity Compliance, the implements processes to prevent fraud, waste, and abuse. Researches and interprets billing and coding guidelines and CMS reimbursement regulations applicable to Hoag service lines. Develops presentations, education and provide training on new standards and conduct audits to ensure compliance. Under limited supervision, supports the operations of the Revenue Integrity Compliance Program which includes special projects, assessment and analysis, performing audits, conducting investigations, responding to compliance questions and working with the revenue cycle departments. Performs other duties as assigned.
Qualifications
Education and Experience
A minimum of four (4) years of relevant compliance and/or revenue cycle experience in an acute care setting or multi-specialty medical group.
Working knowledge of government and commercial billing and coding regulations and guidance. Familiarity with Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs) and other CMS billing and coding guidelines for Hoag services.
Epic Experience Preferred.
Licenses Required N/A
Certifications Required
Certified in Healthcare Compliance (CHC) or other compliance or coding certification subject to approval by the Sr. Principal Revenue Integrity Compliance or must obtain certification within 6 months of hire.
Certifications Preferred
Certified Coder Professional (e.g., CPC, COC, CPMA), or Certified Coding Specialist (CCS)
About Us
Hoag Memorial Hospital Presbyterian is a nonprofit regional health care delivery network in Orange County, California, consisting of three acute-care hospitals with sixteen urgent care centers, eleven health centers and a network of more than1,800 physicians, 100 allied health members, 8,000 employees, and 2,000 volunteers. More than 30,000 inpatients and 550,000 outpatients choose Hoag each year.
For over 70 years, Hoag has delivered a level of personalized care that is unsurpassed among Orange County’s health care providers. Since 1952, Hoag has served the local communities and continues its mission to provide the highest quality health care services through the core strategies of quality and service, people, physician partnerships, strategic growth, financial stewardship, community benefit and philanthropy.
Hoag offers a comprehensive blend of health care services including six institutes providing specialized care in the areas of cancer, heart and vascular, neurosciences, women's health, orthopedics, and digestive health through our institutes.
Hoag was the highest ranked hospital in Orange County in the 2024-2025 U.S. News &World Report, the only Orange County hospital ranked in the top 10 for California. The organization was ranked the #5 hospital in the Los Angeles Metro Area and the #10 hospital in California.
To learn more about Hoag’s awards and accreditations, visit: https://www.hoag.org/about-hoag/awards-accreditations/ .
Hoag is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. Hoag is committed to the principle of equal employment opportunity for all employees and providing employees with a work environment free of discrimination and harassment. Hoag hires a diverse group of people in a manner that allows them to reach their full potential in the pursuit of organizational objectives.
Primary Duties and Responsibilities
The Program Manager Revenue Integrity Compliance supports implementation of the Revenue Integrity Compliance Program for Hoag Memorial Hospital Presbyterian and its affiliated companies (collectively “Hoag”). The Program Manager Revenue Integrity Compliance is a key corporate compliance role providing onsite support of billing, coding and revenue cycle compliance related matters for Hoag enterprise-wide. Possesses working knowledge of revenue cycle operations, regulatory and compliance rules and regulations, various payer reimbursement practices and government billing audits.
In collaboration with the Sr. Principal, Revenue Integrity Compliance, the implements processes to prevent fraud, waste, and abuse. Researches and interprets billing and coding guidelines and CMS reimbursement regulations applicable to Hoag service lines. Develops presentations, education and provide training on new standards and conduct audits to ensure compliance. Under limited supervision, supports the operations of the Revenue Integrity Compliance Program which includes special projects, assessment and analysis, performing audits, conducting investigations, responding to compliance questions and working with the revenue cycle departments. Performs other duties as assigned.
Qualifications
Education and Experience
A minimum of four (4) years of relevant compliance and/or revenue cycle experience in an acute care setting or multi-specialty medical group.
Working knowledge of government and commercial billing and coding regulations and guidance. Familiarity with Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs) and other CMS billing and coding guidelines for Hoag services.
Epic Experience Preferred.
Licenses Required N/A
Certifications Required
Certified in Healthcare Compliance (CHC) or other compliance or coding certification subject to approval by the Sr. Principal Revenue Integrity Compliance or must obtain certification within 6 months of hire.
Certifications Preferred
Certified Coder Professional (e.g., CPC, COC, CPMA), or Certified Coding Specialist (CCS)
About Us
Hoag Memorial Hospital Presbyterian is a nonprofit regional health care delivery network in Orange County, California, consisting of three acute-care hospitals with sixteen urgent care centers, eleven health centers and a network of more than1,800 physicians, 100 allied health members, 8,000 employees, and 2,000 volunteers. More than 30,000 inpatients and 550,000 outpatients choose Hoag each year.
For over 70 years, Hoag has delivered a level of personalized care that is unsurpassed among Orange County’s health care providers. Since 1952, Hoag has served the local communities and continues its mission to provide the highest quality health care services through the core strategies of quality and service, people, physician partnerships, strategic growth, financial stewardship, community benefit and philanthropy.
Hoag offers a comprehensive blend of health care services including six institutes providing specialized care in the areas of cancer, heart and vascular, neurosciences, women's health, orthopedics, and digestive health through our institutes.
Hoag was the highest ranked hospital in Orange County in the 2024-2025 U.S. News &World Report, the only Orange County hospital ranked in the top 10 for California. The organization was ranked the #5 hospital in the Los Angeles Metro Area and the #10 hospital in California.
To learn more about Hoag’s awards and accreditations, visit: https://www.hoag.org/about-hoag/awards-accreditations/ .
Hoag is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. Hoag is committed to the principle of equal employment opportunity for all employees and providing employees with a work environment free of discrimination and harassment. Hoag hires a diverse group of people in a manner that allows them to reach their full potential in the pursuit of organizational objectives.