Health Plan Associate Compliance Program Manager
Health Plan Associate Compliance Program Manager
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Salary Not Disclosed
1 Vacancy
Job Description
What awaits you:
- Work-life balance - M-F 8:30-5:00 minimum of one day a week in our Hanover MD office
- Medical Dental and Vision Insurance.
- 403B Savings Plan w/employer contribution.
- Paid Time off & Paid holidays.
- Employee and Dependent Tuition assistance benefits.
- Health and wellness programs and MORE!
Who you are:
The Associate Compliance Program Manager is responsible for the development implementation and ongoing monitoring activities of the John Hopkins Health Plans (JHHP) Compliance Program with a particular emphasis on analyzing compliance with applicable regulatory and contractual requirements.
Critical to the success of this role the Associate Compliance Program Manager is responsible for independently assessing a variety of complex compliance risk-areas within JHHP in support of the Compliance Departments auditing and monitoring work plan(s). Responsible for independently performing scheduled audits ongoing monitoring activities unplanned investigations and independently providing compliance guidance to JHHP operational areas. He/she uses their judgment and critical thinking skills in recommending appropriate corrective action for non-compliance as well as ensures that corrective action is taken.
What youll do:
- Independently manage and review regulatory requests audits conducted on behalf of JHHP and monitor audits and reviews conducted by regulatory agencies of JHHP programs.
- Gather and review all appropriate contractual internal policy and/or regulatory documentation pertinent to the assigned audit/monitoring process.
- Implement both planned and special audits and monitoring activities to determine compliance with contractual and/or regulatory requirements.
- Complete supporting work papers in accordance with applicable standards
- Conduct unplanned audits as assigned
- Assist in the preparation and execution of educational activities
- Provide presentations to management and operational personnel concerning compliance activities
- Provide guidance and recommendations for remediation where error trends are identified.
- Effectively assess results of auditing and monitoring activities to recommend opportunities for improving controls
- Represent the Compliance Department on various committees/meetings
- Advising Committees on issues impacting program compliance
What youll bring:
- Knowledge in Medicare Maryland Medicaid and other governmental billing regulations is preferred.
- Familiarity with the Maryland regulatory environment and other payer methodology is preferred.
- Ability to research and perform critical analysis of Federal and State regulations associated sub-regulatory guidance and policy.
- Requires strong interpersonal oral and written communication skills
- Ability to draft documentation of substantial complexity including reports policies and procedures.
- Requires the ability to plan and prioritize multiple tasks with little supervision.
Bachelors Degree preferred. Previous health plan and/or compliance plan experience will be considered in lieu of education
Requires a minimum of three (3) years experience in health plan compliance. Previous experience with Programs of All-Inclusive Care (PACE) and Dual Special Needs Plans preferred.
Who we are:
Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine. JHHP is a $3B business serving over 400000 active members with lines of business in Medicaid Medicare commercial military health health solutions and venture investments. JHHP is a leader in provider-sponsored health plans and is poised for future growth.
Many organizations talk about transforming the future of healthcare at Johns Hopkins Health Plans we are setting the pace for change within the healthcare industry. We develop innovative analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for our members and the communities we serve.
Salary Range: Minimum 37.04/hour - Maximum 61.16/ will be commensurate with equity and experience for roles of similar scope and responsibility.
In cases where the range is displayed as a $0 amount salary discussions will occur during candidate screening calls before any subsequent compensation discussion is held between the candidate and any hiring authority.
JHM prioritizes the health and well-being of every employee. Come be healthy at Hopkins!
Diversity and Inclusion are Johns Hopkins Medicine Core Values. We are committed to creating a welcoming and inclusive environment where we embrace and celebrate our differences where all employees feel valued contribute to our mission of serving the community and engage in equitable healthcare delivery and workforce practices.
Johns HopkinsHealth Systemand its affiliatesare an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity and expression age national origin mental or physical disability genetic information veteran status or any other status protected by federal state or local law.
Johns Hopkins Health System and its affiliates are drug-free workplace employers.
Required Experience:
Manager
Employment Type
Full-Time
