Program Director Medicare Compliance
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Job Location:
Hanover, PA - USA
Monthly Salary:
Not Disclosed
Posted on:
21 hours ago
Vacancies:
1 Vacancy
Job Summary
This is a modified hybrid role: 1-2 days per week. Location is Hanover MD.
The Johns Hopkins Health Plan is seeking a driven Program Director - Medicare Compliance to lead our Medicare compliance program and ensure full adherence to CMS and regulatory requirements. This role oversees daily program operations guides compliance strategy and structure manages staff and partners across the organization and with FDRs to promote a strong culture of compliance. The Program Director drives auditing and monitoring efforts leads key committees liaises with regulatory agencies and oversees corrective action and implementation of new guidance to maintain an effective proactive compliance program.
Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine. JHHP is a $3.2B business serving nearly 500000 members with lines of business in Medicaid Medicare commercial military health health solutions and venture investments. JHHP is a leader in provider sponsored health plansbacked by the clinical expertise of Johns Hopkins Medicineand is poised for future growth.
Education/Certification:
- Bachelors degree in Health Management Business or other applicable concentration
- Masters degree or Juris Doctorate preferred
- Certification in Health Care Compliance Fraud Examination or Internal Audit is preferred
Requirements:
- A minimum of 5-7 years in a Medicare Compliance program and 3-5 years of management and supervisory experience
- Knowledge of CMS Medicare Advantage and Part D contractual and regulatory requirements
- 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
- Understanding of Maryland payment methodology and Health Services Cost Review Commission strongly preferred
- Ideal candidate will come from a health plan background and claims management experience is especially valuable
This role requires strong critical thinking strategic problemsolving and the ability to communicate complex compliance requirements clearly. Candidates should excel in interpersonal communication customer service and collaboration across all organizational levels. Strong analytical ability data interpretation skills and project management capabilitiesincluding planning implementation and reportingare essential. Proficiency with Microsoft Office applications and statistical audit tools is required along with the ability to research regulations manage multiple priorities and meet tight deadlines with minimal supervision.
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. If you are interested in improving how healthcare is delivered and have a passion to be at the forefront of change JHHP is the place to call home.
What We Offer:
Johns Hopkins Health Plans is an organization that recognizes and rewards excellence and encourages professional development. Employee rewards recognition camaraderie and support are just a few of our many benefits include tuition assistance dependent college tuition program 403(b) retirement savings health dental vision and prescription coverage disability and life insurance paid time off and holidays.
Salary Range: Minimum 103605.00/annually - Maximum 181334.00/annually. Compensation 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.
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 Hopkins Health System and its affiliates are an Equal Opportunity 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
Key Skills
- Nurse Management
- Program Management
- Employee Evaluation
- Management Experience
- Teaching
- Curriculum Development
- Administrative Experience
- Budgeting
- Leadership Experience
- Program Development
- Supervising Experience
- Addiction Counseling
About Company
Johns Hopkins Medicine is a leading health system and academic institution in the U.S. Find information about doctors, locations, appointments, billing, research, education and more.
