Medicare Compliance Director (Hybrid)

Johns Hopkins Medicine; Hanover (MD); Hybrid; USD 104,000 - 181,000; Full time

Job summary

Johns Hopkins Health Plans is seeking a Program Director - Medicare Compliance to lead the Medicare compliance program and ensure CMS and regulatory adherence. Responsibilities include guiding strategy, overseeing audits, and coordinating with internal teams and external partners to maintain a proactive compliance posture.

The role requires 5–7 years in Medicare compliance and 3–5 years of management, with strong HIPAA, CMS, and Maryland-related knowledge.

Qualifications

• Minimum 5-7 years in a Medicare Compliance program
• 3-5 years of management/supervisory experience
• Knowledge of CMS Medicare Advantage and Part D requirements
• Expert level HIPAA and related regulations
• Understanding Maryland payment methodology preferred
• Health plan or claims management background preferred

Responsibilities

• Lead Medicare compliance program and auditing efforts
• Oversee daily program operations and staff
• Develop compliance strategy and structure
• Collaborate across the organization and with FDRs
• Liaise with regulatory agencies
• Oversee corrective action and implementation of guidance

Skills

Medicare Compliance

CMS Regulations

HIPAA Knowledge

Project Management

Data Analysis

Communication Skills

Education

Bachelor's in Health Management or Business

Master's or JD preferred

Health Care Compliance certification preferred

Tools

Microsoft Office

Statistical Audit Tools

Job description

Johns Hopkins Health Plans is seeking a Program Director - Medicare Compliance to lead the Medicare compliance program and ensure CMS and regulatory adherence. Responsibilities include guiding strategy, overseeing audits, and coordinating with internal teams and external partners to maintain a proactive compliance posture.

The role requires 5–7 years in Medicare compliance and 3–5 years of management, with strong HIPAA, CMS, and Maryland-related knowledge.