Program Director of Medicare Compliance
Program Director of Medicare Compliance
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Job Description
Job requires candidate to be onsite every Wednesday.
Position Summary
The Program Director of Medicare Compliance reports to the Executive Director of Compliance and Regulatory Affairs. The role provides verbal and written reports to the President and CEO of JHHP senior executives of JHHS (parent entity of JHHP) and the Hopkins Health Advantage (HHA) Board of Directors.
The Program Director of Medicare Compliance is directly responsible for the development and implementation of an effective Medicare compliance program that focuses on detection correction and prevention and is compliant with regulatory requirements. The role is responsible for the following activities:
- The day-to-day management of the Medicare Compliance Program chairs the Medicare Compliance Committee and subcommittees of the Medicare Compliance Committee and management/growth of Compliance staff.
- Define the Medicare compliance program structure that includes applicable policies and procedures educational requirements including time frames reporting complaint mechanisms (e.g. CTMs hotlines etc.) response and correction procedures and sets compliance expectations of all personnel and First Tier Downstream and Related Entities (FDRs).
- Work with management staff and FDRs to ensure that systems standards and processes are in place to identify and implement applicable compliance requirements ascertain compliance risk and mitigation strategies when appropriate and promote a culture of compliance.
- Develop and implement a routine auditing and monitoring workplan and resources.
- Solicit input and feedback from management staff committees and governing board on the development implementation and effectiveness of the Medicare Compliance Program.
- Liaison with the Centers for Medicare & Medicaid Services (CMS) as well as other regulatory agencies regarding JHHPs Medicare Advantage and/or Part D business.
- Coordinate with management and staff to ensure oversight and management to regulatory requirements of FDRs.
- Collaborate with Compliance colleagues
- Provides oversight of the development and monitoring of the corrective actions for noncompliance.
- Ensure the distribution and tracking of implementation when applicable of regulatory guidance such as HPMS memos etc.
- Other duties and activities as assigned or otherwise to ensure an effective compliance program.
Qualifications:
- Bachelors degree in health management Business or other applicable concentration.
- Masters Degree or Juris Doctorate preferred.
- Job requires a minimum of 5 to 7 years in a Medicare Compliance program
- Requires 3 to 5 years of management and supervisory experience.
- Certification in Health Care Compliance Fraud Examination or Internal Audit is preferred.
- Requires essential knowledge of CMS Medicare Advantage and Part D contractual and regulatory requirements.
- Requires the ability to communicate effectively verbally and in writing.
- Requires the ability to work effectively with staff management and a Board of Program Directors.
- Expert level knowledge of HIPAA requirements 42 CFR 422 42 CFR 423 Inflation Reduction Act OIG Compliance Guidelines and other key regulations related to public health care.
- Understanding of Maryland payment methodology and Health Services Cost Review Commission strongly preferred.
Salary Range: $116000 per year - $150000 per year. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility
Johns Hopkins Medicine 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 practice.
Johns Hopkins Health System and its affiliates are 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:
Director
Employment Type
Full-Time
