$200K - $250K(Ladders Estimates)
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.
The Senior Director of Corporate Compliance ("Sr. Director") reports directly to the Johns Hopkins Health System Chief Compliance Officer. The Sr. Director is responsible for the development, implementation, communication, and monitoring of all compliance activities for the Plans' Programs.
The Sr. Director is responsible for ensuring that the health plans (Priority Partners MCO, Johns Hopkins US Family Health Plan and Employer Health Programs) administered by JHHC are fully compliant with all federal and state regulations, contractual mandates and accreditation requirements.
The Sr. Director is responsible for developing Compliance and Program Integrity plans for the Johns Hopkins HealthCare and for monitoring compliance to those plans. He or she directs programs, policies, and practices to ensure that all business units are in compliance with financial policy and reporting regulations.
The Sr. Director has overall responsibility for the operation and oversight of JHHC ensuring that systems, standards, and processes are in place to reduce compliance risks; identifying, investigating, and addressing all instances of alleged and actual noncompliance; and promoting compliant and ethical behavior throughout the organization and with its delegates.
The Sr. Director maintains an ongoing relationship with legal counsel and all applicable regulatory authorities in connection with the administration of the Compliance Program and, when appropriate, consults independent outside counsel to assist with significant compliance issues. The Sr. Director is responsible for making regular reports regarding compliance activities to the Board of Directors, the President of Johns Hopkins HealthCare and other Executives within the Johns Hopkins Health System, and, the Johns Hopkins Health System Chief Compliance Officer. The Sr. Director dually reports directly and unfiltered to the President of JHHC, the JHHS Chief Compliance Officer as well as entity's governing board. The frequency of reporting is as follows: 1) at a minimum of monthly to the Chief Compliance Officer, 2) at a minimum of quarterly to the JHHC Compliance Oversight Committee, and 3) at a minimum of bi-annually to the JHHC governing board.
In addition, the Sr. Director provides the Johns Hopkins Health System Chief Compliance Officer, with at least monthly updates on Department activities. Reporting may include but is not limited to compliance plan outcomes including results of internal and external audits, governmental agency enforcement activity, and periodic reporting of compliance activity for operational areas. The governing board for JHHC has ultimate oversight for the implementation and effectiveness of the Compliance Plan. Based upon reports from the Sr. Director, the governing board may make further inquiries and make recommendations on appropriate action to ensure issues are resolved.
Bachelor's Degree in Nursing, Health Administration, Business Administration, or other appropriate field is required. Master's Degree is preferred. Post graduate certificate in Health Care Compliance is preferred.
Requires a professional level of knowledge in compliance, business, insurance, or health care administration.
Requires essential knowledge of health care regulatory requirements and the ability to effectively communicate (oral and written media).
Requires professional level of knowledge of health care and managed care delivery systems.
Requires a professional level of knowledge of medical, ICD9CM, ICD10, CPT and HCPCS coding terminology and documentation standards and guidelines.
Requires knowledge of the relevant Federal and State legislation/regulations and contractual obligations for each lines of business.
Requires knowledge of insurance claim filing and billing principles.
Requires knowledge of relational databases; previous SQL experience preferred.
Requires extensive knowledge in planning, retrieval, monitoring, analyzing, and reporting of data.
Requires the ability to define project scope, develop a plan of action, implementation, monitoring and outcome reporting.
Requires demonstrated ability to consistently inspire and lead a team to successful outcomes.
Requires strong analytical ability to solve complex problems. Must possess advanced interpersonal skills to effectively interface with all levels of staff as well as external regulatory agents.
Must possess advanced interpersonal, written, and oral skills to effectively interface with all levels of staff, contracted providers, all levels of management, and external regulatory agents.
Requires the ability to research, understand, and communicate compliance obligations of substantial complexity, including state and federal statutes and regulations. Must be able to convert compliance regulations into a logical and practical audit tool or scope document.
Requires strong computer skills in standard PC word processing, spreadsheet and database applications (such as those found in the Microsoft Office Suite).
Requires skill in using statistical audit software to create and understand reports showing negative trends in billing and documentation practices.
Requires the ability to plan and prioritize multiple tasks with minimal supervision.
Requires high level analytical skills, and the ability to define data analysis requirements
and propose formats and strategies to address business questions
D. Required Licensure, Certification, Etc.:
Active CPC or CCS coding certification strongly preferred. Certification in Health Care Compliance strongly preferred. Active State of Maryland licensure is required if candidate is an RN.
E. Work Experience:
Job requires a minimum of 7 years' experience in compliance, managed care or health care, including demonstrated experience in governmental programs (Medicare Managed Care and Managed Medicaid strongly preferred), health care compliance, medical record/claim/financial auditing, and managerial experience.
Requires demonstrated experience in compliance, a managed care environment such as health plan operations, law and/or governmental relations.
Requires 5 years of management experience.
Valid Through: 2019-10-21