Job Description

Job requires candidate to be onsite every Wednesday.

Position Summary

The Program Director of Medicare Compliance reports to the Executive Director of Compliance and Regulatory Affairs. The role provides verbal and written reports to the President and CEO of JHHP, senior executives of JHHS (parent entity of JHHP) and the Hopkins Health Advantage (HHA) Board of Directors.

The Program Director of Medicare Compliance is directly responsible for the development and implementation of an effective Medicare compliance program that focuses on detection, correction and prevention and is compliant with regulatory requirements. The role is responsible for the following activities:

• The day-to-day management of the Medicare Compliance Program chairs the Medicare Compliance Committee and subcommittees of the Medicare Compliance Committee, and management/growth of Compliance staff.
• Define the Medicare compliance program structure that includes applicable policies and procedures, educational requirements including time frames, reporting, complaint mechanisms (e.g. CTMs, hotlines, etc.), response and correction procedures, and sets compliance expectations of all personnel and First Tier, Downstream and Related Entities (FDRs).
• Work with management, staff, and FDRs to ensure that systems, standards and processes are in place to identify and implement applicable compliance requirements, ascertain compliance risk and mitigation strategies when appropriate, and promote a culture of compliance.
• Develop and implement a routine auditing and monitoring workplan and resources.
• Solicit input and feedback from management, staff, committees and governing board on the development, implementation and effectiveness of the Medicare Compliance Program.
• Liaison with the Centers for Medicare & Medicaid Services (CMS) as well as other regulatory agencies regarding JHHP’s Medicare Advantage and/or Part D business.
• Coordinate with management and staff to ensure oversight and management to regulatory requirements of FDRs.
• Collaborate with Compliance colleagues
• Provides oversight of the development and monitoring of the corrective actions for noncompliance.
• Ensure the distribution and tracking of implementation, when applicable of regulatory guidance such as HPMS memos, etc.
• Other duties and activities as assigned or otherwise to ensure an effective compliance program.

Qualifications:

• Bachelor’s degree in health management, Business or other applicable concentration.
• Master’s Degree or Juris Doctorate preferred.
• Job requires a minimum of 5 to 7 years in a Medicare Compliance program
• Requires 3 to 5 years of management and supervisory experience.
• Certification in Health Care Compliance, Fraud Examination or Internal Audit is preferred.
• Requires essential knowledge of CMS’ Medicare Advantage and Part D regulatory requirements.
• Requires the ability to communicate effectively, verbally and in writing.
• Requires the ability to work effectively with staff, management and a Board of Program Directors.
• Expert level knowledge of HIPAA requirements, 42 CFR 422, 42 CFR 423, Inflation Reduction Act, OIG Compliance Guidelines, and other key regulations related to public health care.
• Understanding of Maryland payment methodology and Health Services Cost Review Commission strongly preferred.

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