Johns Hopkins Health System employs more than 20,000 people annually. Upon joining Johns Hopkins Health System, you become part of a diverse organization dedicated to its patients, their families, and the community we serve, as well as to our employees. Career opportunities are available in academic and community hospital settings, home care services, physician practices, international affiliate locations and in the health insurance industry. If you share in our vision, mission and values and also have exceptional customer service and technical skills, we invite you to join those who are leaders and innovators in the healthcare field.
This position reports to the Director of Billing Compliance and 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.
The successful candidate independently assesses 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. Uses judgment and critical thinking in determining appropriate corrective action for non-compliance as well as ensures that corrective action is taken by the affiliate. Responsible for monitoring and responding to certain regulatory requests and representing the Compliance Department on various committees as requested.
Provides regular guidance and advice to JHHS personnel, leadership and Executive Management in compliance related areas. Conducts independent research in the areas of Medicare and Medicaid and other complex legal authorities pertaining to billing and regulatory compliance. Responsibilities include the development of 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.
Manages audits conducted by vendors and payers and provide regular status reports to senior management. Additionally, the position is responsible for reviewing the draft work product of their peers and to mentor and assist in the training and development of the compliance staff.
Full-time, Day Shift
8:30 a.m. - 5:00 p.m.
Work Location: 1812 Ashland Avenue, Suite 300, Baltimore, MD 21205
Requires a minimum of a Bachelor’s degree. A Bachelor’s Degree in Nursing or a Juris Doctor is preferred. Experience beyond the required work experience may be substituted for the degree on a 2 to 1 basis. With every two years’ experience equal to one year of education.
Required Licensure, Certification, Etc.:
For a BSN, requires an active RN license in good standing with the Maryland State Board of Nursing, or another State’s Board.
For a JD, requires an active license to practice law, in good standing, from the Maryland State Board of Law Examiners or another State’s Board.
Requires a minimum of 5 years medical coding, auditing or related experience. For a JD or other legal professional, experience in healthcare claims, billing, or other health care reimbursement area is required in lieu of medical coding and auditing. For an RN, experience in utilization review or health care reimbursement is preferred.
A Professional level of knowledge of billing practices and procedures. In depth knowledge in the areas of Medicare, Maryland Medicaid, and commercial insurance billing regulations. Familiarity with the Maryland regulatory environment and other payer methodology is preferred. Knowledge of basic coding and healthcare licensing/accreditation standards is required as is knowledge of other state and federal laws and regulations which affect corporate compliance operations.
Requires strong interpersonal, oral, and written communication skills; the 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.
Ability to draft documentation of substantial complexity including reports, policies and procedures.
Requires the ability to plan and prioritize multiple tasks without supervision.
Requires analytical abilities in order to effectively monitor billing and other issues, calculate over and underpayments and report thereon.
Requires the ability to prepare and conduct educational presentations.
Requires the ability to coordinate audits performed by government and private payers as well as auditors contracted by JHHS entities.
Requires ability to make autonomous decisions in assessing and managing compliance risk.
"Johns Hopkins Hospital is a Smoke Free Campus"
Johns Hopkins Health System and its affiliates are drug-free workplace employers.
Johns Hopkins Health System and its affiliates are an Equal Opportunity / Affirmative Action employers. 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.