About the position
The Associate Compliance Program Manager is responsible for the development, implementation, and ongoing monitoring activities of the John Hopkins Health Plans ('JHHP') Compliance Program with a particular emphasis on analyzing compliance with applicable regulatory and contractual requirements. Critical to the success of this role, the Associate Compliance Program Manager is responsible for independently assessing a variety of complex compliance risk-areas within JHHP in support of the Compliance Department's auditing and monitoring work plan(s). Responsible for independently performing scheduled audits, ongoing monitoring activities, unplanned investigations, and independently providing compliance guidance to JHHP operational areas. He/she uses their judgment and critical thinking skills in recommending appropriate corrective action for non-compliance as well as ensures that corrective action is taken.
Responsibilities
- Independently manage and review regulatory requests, audits conducted on behalf of JHHP, and monitor audits and reviews conducted by regulatory agencies of JHHP programs.
- Gather and review all appropriate contractual, internal policy and/or regulatory documentation pertinent to the assigned audit/monitoring process.
- Implement both planned and special audits and monitoring activities to determine compliance with contractual and/or regulatory requirements.
- Complete supporting work papers in accordance with applicable standards.
- Conduct unplanned audits as assigned.
- Assist in the preparation and execution of educational activities.
- Provide presentations to management and operational personnel concerning compliance activities.
- Provide guidance and recommendations for remediation where error trends are identified.
- Effectively assess results of auditing and monitoring activities to recommend opportunities for improving controls.
- Represent the Compliance Department on various committees/meetings.
- Advising Committees on issues impacting program compliance.
Requirements
- Knowledge in Medicare, Maryland Medicaid, and other governmental billing regulations is preferred.
- Familiarity with the Maryland regulatory environment and other payer methodology is preferred.
- Ability to research and perform critical analysis of Federal and State regulations, associated sub-regulatory guidance and policy.
- Requires strong interpersonal, oral, and written communication skills.
- Ability to draft documentation of substantial complexity including reports, policies and procedures.
- Requires the ability to plan and prioritize multiple tasks with little supervision.
- Bachelor's Degree preferred.
- Requires a minimum of three (3) years' experience in health plan compliance.
- Previous health plan and/or compliance plan experience will be considered in lieu of education.
- Previous experience with Programs of All-Inclusive Care (PACE) and Dual Special Needs Plans preferred.
Benefits
- Work-life balance - M-F 8:30-5:00, minimum of one day a week in our Hanover, MD office.
- Medical, Dental, and Vision Insurance.
- 403B Savings Plan w/employer contribution.
- Paid Time off & Paid holidays.
- Employee and Dependent Tuition assistance benefits.
- Health and wellness programs and MORE!
