Compliance Program Manager, Professional Fee

Johns Hopkins Medicine; Baltimore (MD); On-site; USD 100,000 - 125,000; Full time

Job summary

An established industry player is seeking a Compliance Program Manager to lead the Corporate Compliance Program. This role involves ensuring billing accuracy, conducting audits, and providing training across the healthcare system. The ideal candidate will have a strong background in compliance and auditing, with a focus on regulatory requirements. Join a diverse and collaborative environment where growth and development are prioritized, and contribute to a mission of equitable healthcare delivery. This position offers a competitive salary and a comprehensive benefits package, making it an exciting opportunity for professionals in the healthcare compliance field.

Benefits

Employee Tuition Assistance

Comprehensive Benefits Package

Career Growth Opportunities

Diverse Working Environment

Qualifications

• Minimum 5 years in healthcare, coding, auditing, or related fields.
• Requires professional coding certification (CCS-P, CPC, RHIA, or RHIT).

Responsibilities

• Oversee the Corporate Compliance Program and ensure billing compliance.
• Conduct audits and provide compliance guidance to JHHS personnel.

Skills

Compliance Risk Assessment

Auditing Techniques

Documentation Accuracy

Provider Education

Critical Thinking

Education

Bachelor's Degree

Tools

Coding Software

Job description

YOU BELONG HERE

What Awaits You?

• Career growth and development
• Employee and Dependent Tuition Assistance
• Diverse and collaborative working environment
• Affordable and comprehensive benefits package

Our competitive Benefit Package is designed to support the well-being and financial security of our employees. You can explore the details of our benefits offering by visiting the following link:https://jhhs.mybenefitsjhhs.com/

Summary:

The Compliance Program Manager – Professional Fee Compliance is responsible for the development, implementation, and ongoing oversight of the Corporate Compliance Program, with a particular focus on federal payor billing compliance, provider education, and documentation accuracy across the Johns Hopkins Health System Corporation (JHHS) and its affiliates. The role involves working closely with the clinical departments, Physicians Billing Service, and the School of Medicine. The position will be responsible for providing ongoing training and support to physicians, non-physician providers, professional fee billing staff, clinic staff, administrators, and other affected personnel on documentation and billing requirements. Using auditing and analysis techniques, the individual will determine the adequacy of medical records documentation, coding, and billing for all providers across all clinical specialties.

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. The Compliance Program Manager must use judgment and critical thinking skills in determining appropriate corrective action for non-compliance as well as ensure 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 pertaining to billing and regulatory compliance. Responsibilities include developing education and training for management and staff regarding governmental 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 providing regular status reports to senior management. Additionally, he/she will be responsible for reviewing the draft work product of their peers and mentoring and assisting in the training and development of the compliance staff.

JHHS Physician entities included in the scope of responsibility include but are not limited to:

Johns Hopkins Community Physicians, Johns Hopkins Regional Physicians, and Johns Hopkins All Children’s Specialty Physicians.

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

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

Highly Preferred Qualifications:

• A minimum of one professional coding certification (CCS-P, CPC, RHIA, or RHIT)
• Valued additional coding, billing, or auditing certifications (CPMA, CRC, CPB, CEMC)

Salary Range: Minimum 40.39/hour - Maximum 64.63/hour. 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.

JHM prioritizes the health and well-being of every employee. Come be healthy at Hopkins!

Diversity and Inclusion are Johns Hopkins Medicine Core Values. 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.