Compliance Program Manager

Compliance Program Manager

The Compliance Program Manager is responsible for the development, implementation, and ongoing monitoring of the Corporate Compliance Program with a particular emphasis on federal payor billing compliance and compliance-related education for the Johns Hopkins Health System Corporation and its affiliates. Critical to the success of this role, the Compliance Program Manager is responsible for independently assessing a variety of complex compliance risk areas within the JHHS affiliates to develop the Compliance Department's work plan. Responsible for independently performing scheduled audits required by the work plan, unplanned investigations, and, in carrying out these activities, independently providing compliance guidance to JHHS personnel. He/she uses judgment and critical thinking skills in determining appropriate corrective action for non-compliance, as well as ensuring that corrective action is taken by the affiliate. Additionally, responsible for monitoring and responding to certain regulatory requests and representing the Compliance Department on various committees as requested. This position will provide regular guidance and advice to JHHS personnel, leadership, and Executive Management in compliance-related areas. Conducting independent research in the areas of Medicare and Medicaid and other complex legal authorities about billing and regulatory compliance. Responsibilities include developing education and training for management and staff regarding federal payor regulatory requirements and other compliance matters based on the incumbent's independent judgment of the affiliate's educational needs. This position will also manage audits conducted by vendors and payers, and provide regular status reports to senior management. Additionally, he/she will be responsible for reviewing the draft work product of their peers, mentoring, and assisting in the training and development of the compliance staff.

Essential Functions

• Developing audit work plans and conducting or supervising both planned and special audits of patient medical records and bills to determine whether charges being billed are adequately supported by documentation in the record, and that documented services are being billed
• Gathering all appropriate medical records, billing documents, and research statutes, regulations, and policies pertinent to the audit process
• Auditing medical records and related billing records according to the plan
• Completing supporting work papers in accordance with applicable standards
• Conducting unplanned audits and securing all applicable documentation to complete the review
• Reviewing reports and other work products prepared by Compliance Auditing Staff to help guide the development of Compliance Auditors' adherence to Compliance audit work plans and research requirements
• Preparing and conducting education for any applicable areas for which Compliance education efforts have been identified
• Preparing training materials (e.g., overheads, copies of Medicare bulletins, manuals, etc.) to facilitate effective training sessions and providing personnel with subsequent reference tools at their workstation
• Reviewing training material developed by Compliance Auditors
• Providing informational presentations to management and operational personnel concerning the compliance audit
• Assisting in employee billing compliance training as it relates primarily to documentation requirements
• Providing guidance and recommendations for change where error trends are identified
• Recommending improvements to reduce or eliminate documentation and billing deficiencies, and assessing risk related to billing deficiencies
• Effectively using the results of audits to recommend opportunities for improving controls over the documentation and billing processes
• Representing the Compliance Department on various committees and before regulatory bodies
• Advising Committees on issues impacting billing compliance
• Independently managing and reviewing regulatory requests, audits conducted by vendors on behalf of JHHS, and monitoring audits and reviews conducted by regulatory agencies of JHHS entities
• Effectively directing outside vendors in completing audits requested by the Compliance Department

Knowledge, Skills, and Abilities

A professional level of knowledge of billing practices and procedures is required. In-depth knowledge in the areas of Medicare, Maryland Medicaid, and other governmental billing regulations is preferred. Knowledge of the Maryland regulatory environment and other payer methodologies. Advanced knowledge of coding, auditing, or healthcare licensing/accreditation standards is required, as is knowledge of other state and federal laws and regulations that affect corporate compliance operations. Requires strong interpersonal, oral, and written communication skills. The strong ability to interact and communicate independently and effectively with all levels of management and staff is essential. Demonstrated ability to research and perform critical analysis of complex billing and compliance law, regulation, and policy. Strong ability to draft documentation of substantial complexity, including reports, policies, and procedures.

Requires a strong ability to plan and prioritize multiple tasks with little supervision. Requires analytical abilities to effectively monitor billing and other issues, calculate over and underpayments, and report thereon. Requires a strong ability to prepare and conduct educational presentations. Requires a strong ability to coordinate audits performed by government and private payers, as well as auditors contracted by JHHS entities. Requires the ability to make autonomous decisions in assessing and managing compliance risk.

Education: Requires a minimum of a Bachelor's degree.

Work Experience: Requires a minimum of five (5) years' experience in health care (clinical or otherwise), coding, auditing, utilization management, or related experience.

Salary Range: $41.00/hour - $65.60/hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility.

The Hospital reserves the right to modify employee schedules as needed.

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 drug-free workplace employers.

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.