Medicare Compliance Program Director

Johns Hopkins Health Plans; Maryland; Hybrid; USD 104,000 - 181,000; Full time

Benefits offered by this job

Tuition assistance

403(b) retirement savings

Health insurance

Dental & Vision

Prescription coverage

Disability & life insurance

Paid time off

Job summary

Johns Hopkins Health Plans in Hanover, MD is seeking a Program Director - Medicare Compliance to lead our Medicare compliance program, ensuring adherence to CMS and regulatory requirements. This role oversees daily operations, guides strategy, manages staff, and partners across the organization and with FDRs to promote a strong culture of compliance.

The Johns Hopkins Health Plan is a managed care entity serving nearly 500,000 members with lines of business in Medicaid, Medicare, commercial and

Qualifications

• Minimum 5-7 years in a Medicare Compliance program and 3-5 years of management and supervisory experience.
• Knowledge of CMS Medicare Advantage and Part D contractual and regulatory requirements.
• Expert knowledge of HIPAA, 42 CFR 422/423, Inflation Reduction Act, OIG Compliance Guidelines and related regulations.

Responsibilities

• Lead daily program operations and compliance strategy.
• Oversee auditing and monitoring efforts and key committees.
• Liaise with CMS/regulators and internal stakeholders; implement new guidance.
• Manage staff and vendor partnerships to sustain a proactive compliance program.

Skills

Medicare Compliance

CMS Regulations

HIPAA & 42 CFR

Regulatory Audits

Staff Management

Education

Bachelor’s degree in Health Management or related field

Master’s degree preferred

Certification in Health Care Compliance or Internal Audit preferred

Tools

Microsoft Office

Stats/Audit Tools

Job description

Johns Hopkins Health Plans in Hanover, MD is seeking a Program Director - Medicare Compliance to lead our Medicare compliance program, ensuring adherence to CMS and regulatory requirements. This role oversees daily operations, guides strategy, manages staff, and partners across the organization and with FDRs to promote a strong culture of compliance.

The Johns Hopkins Health Plan is a managed care entity serving nearly 500,000 members with lines of business in Medicaid, Medicare, commercial and