Program Director Baltimore, Maryland, United States

The ACI Group - Baltimore, MD

Full-time - Senior

Baltimore, MD

Professional, Scientific, and Technical Services

About the position

The Program Director will manage and lead a team providing contracted support to the Centers for Medicare & Medicaid Services (CMS). This role involves overseeing the quality and timely management of the program, ensuring compliance with healthcare policies, and collaborating with various stakeholders to minimize fraud, waste, and abuse in medical claims processing. The Program Director will also play a key role in bridging cultural gaps within the organization and enhancing the corporate brand through effective leadership.

Responsibilities

• Manage and direct the contracted program supporting CMS to minimize fraud, waste, and abuse in medical claims processing.
• Serve as the primary point of management for both internal staff and external vendor personnel.
• Interpret healthcare procedures and services into medical code sets under the NCCI program.
• Oversee and improve NCCI edit programs to prevent improper payments.
• Ensure timely and quality delivery of contracted deliverables to the client.
• Evaluate claim information to ensure compliance with CMS payment and coverage policies.
• Collaborate with CMS stakeholders on program expectations and priorities.
• Maintain strong customer service and communication with CMS leadership.
• Research and analyze data to resolve issues and apply relevant policies and regulations.
• Enhance the corporate brand through effective leadership and management skills.

Requirements

• 10+ years of experience managing a team of 6+ direct reports in medical coding, clinical, data, or healthcare compliance/policy.
• 8+ years of experience with Correct Coding Initiatives, particularly the National Correct Coding Initiative (NCCI).
• 6+ years of project management experience overseeing large projects, budgets, and staff.
• 4+ years of experience managing a Federal contract with direct communication to active Federal clients.
• 9+ years of experience in interpreting/coding HCPCS/CPT codes and coding conventions.
• Experience with Medicare and Medicaid payment, coverage, and coding policies.
• 4+ years of experience working with Azure SQL database environments.
• Advanced expertise in Microsoft Office 365 applications, particularly Excel.

Nice-to-haves

• Current medical coding certification (RHIA, RHIT, CCS, CCS-P, CPC, or CPC-H).
• Bachelor's degree from an accredited university or college.

Benefits

• $1000 Referral Bonus
• Full benefits package including varied types of contract, permanent, and contract-to-perm positions.