Summary

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 using judgment and critical thinking skills in determining appropriate corrective action for non-compliance as well as ensures 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 be providing 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 pertaining to billing and regulatory compliance. Responsibilities include the 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 be managing 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 and to mentor and assist in the training and development of the compliance staff.

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.

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 record, billing documents, and researches statute, regulation and policy 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 secures all applicable documentation to complete the review
• Reviewing reports and other work products prepared by Compliance Auditing Staff to help guide development of Compliance Auditor’s 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 assesses risk related to billing deficiencies
• Effectively using 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

***Effective January 1st 2022, you must be fully vaccinated with an FDA COVID-19 vaccination and provide proof of your vaccination status as part of your new employee pre-boarding. Exceptions to the COVID-19 vaccination requirement may be granted for medical reasons and religious beliefs. Requests for medical exceptions must be submitted at your occupational health screening. In the wake of the COVID-19 pandemic, the Johns Hopkins Health System remains committed to providing the highest quality care for our patients and our communities.

***Authorization to Work in the United States: Applicants who require sponsorship now or in the future will not be considered for this position.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.

We are committed to providing a healthy and safe environment for our patients, visitors and staff members. The Johns Hopkins Hospital has a tobacco-free at work policy. Employees must refrain from using any tobacco products during their work shifts — including while at lunch or on breaks, and whether they are on or off campus.