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.
QualificationsEducation 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 UsHoag 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.
Skills Required
- 4 years of relevant compliance or revenue cycle experience in healthcare
- Working knowledge of billing and coding regulations
- Certified in Healthcare Compliance (CHC) or other certification
- Epic experience
- Certified Coder Professional (CPC, COC, CPMA) or Certified Coding Specialist (CCS)
Hoag Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Hoag and has not been reviewed or approved by Hoag.
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Healthcare Strength — Health, dental, vision, mental health, disability, and wellness programs are extensive, with additions like FSAs and pet insurance. These offerings are presented as comprehensive and a meaningful component of total rewards.
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Leave & Time Off Breadth — Generous PTO, paid holidays and sick time, and parental leave feature prominently. These time-off provisions are described as supportive of work-life balance across roles, including fellowship programs.
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Career-Linked Recognition & Rewards — Tuition reimbursement, continuing education stipends, certification bonuses, and a clinical ladder link development to higher pay and broader involvement. Promote-from-within practices further connect performance and growth to compensation over time.
Hoag Insights
What We Do
Since 1952, Hoag has been serving the local communities of Orange County by providing personalized health care services of an unsurpassed level. Hoag Digital Health is a new customer-centric product management, design, and engineering unit on a mission to bring together Hoag's nationally renowned care in key medical specialties with the everyday experience of primary, urgent, and preventative care and well-being through a variety of digital mediums.
Why Work With Us
To date, we have been helping fundamentally rethink the care experience for multiple customer groups with hybrid digital-physical solutions – from becoming go-to guides for first-time parents delivering at Hoag through re-imagining the primary care and annual wellness experience to improving Hoag’s “digital front doors,” including its websites.
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