Compliance Manager
Johns Hopkins Health System Corporation - Baltimore, MD

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  • Bachelor's
Position Summary:
Position located in St Petersburg, Florida All Children's Hospital

This position reports to the Director of Billing Compliance and is responsible for the development, implementation, and ongoing monitoring of the Corporate Compliance Program with a particular emphasis on federal payor billing compliance and compliance related education for the Johns Hopkins Health System Corporation and its affiliates.

The position independently assesses a variety of complex compliance risk-areas within the JHHS affiliates to develop the Compliance Department’s work plan. This position is responsible for independently performing scheduled audits required by the work plan, unplanned investigations and in carrying out these activities independently providing compliance guidance to JHHS personnel. This position uses judgment and critical thinking in determining appropriate corrective action for non-compliance as well as ensures that corrective action is taken by the affiliate. This position is responsible for monitoring and responding to certain regulatory requests and representing the Compliance Department on various committees as requested.

This position provides regular guidance and advice to JHHS personnel, leadership and Executive Management in compliance related areas. The position conducts independent research in the areas of Medicare and Medicaid and other complex legal authorities pertaining to billing and regulatory compliance. Responsibilities include the development of education and training for management and staff regarding federal payor regulatory requirements and other compliance matters based on the incumbent’s independent judgment of the affiliate’s educational needs.

The position will also manage audits conducted by vendors and payers and provide regular status reports to senior management. Additionally, the position is responsible for reviewing the draft work product of their peers and to mentor and assist in the training and development of the compliance staff.

Compliance Manager: The Compliance Manager is responsible for all duties and requirements listed above. In addition, the Compliance Managers will also be assigned to: 1) Facilities or organizations with greater billing complexity, including unique lines of service or business; 2) Facilities or organizations with a large number of inpatient beds, an FTE staff of 3000 or more, and significant outpatient billing; 3) Facilities or organizations where reviews of professional fee billing in addition to facility fee billing must be conducted; or 4) Provide overall clinical support or oversight to all employees within the Compliance Department.

Education: Requires a minimum of a Bachelor’s degree. A Bachelor’s Degree in Nursing or a Juris Doctor is preferred. Experience beyond the required work experience may be substituted for the degree on a 2 to 1 basis. With every two years’ experience equal to one year of education.

Knowledge: A Professional level of knowledge of billing practices and procedures. In depth knowledge in the areas of Medicare, Maryland Medicaid, and commercial insurance billing regulations. Familiarity with the Maryland regulatory environment and other payer methodology is preferred. Knowledge of basic coding and healthcare licensing/accreditation standards is required as is knowledge of other state and federal laws and regulations which affect corporate compliance operations.

Skills: Requires strong interpersonal, oral, and written communication skills; the ability to interact and communicate independently and effectively with all levels of management and staff is essential. Demonstrated ability to research and perform critical analysis of complex billing and compliance law, regulation and policy. Ability to draft documentation of substantial complexity including reports, policies and procedures. Requires the ability to plan and prioritize multiple tasks without supervision. Requires analytical abilities in order to effectively monitor billing and other issues, calculate over and underpayments and report thereon. Requires the ability to prepare and conduct educational presentations. Requires the ability to coordinate audits performed by government and private payers as well as auditors contracted by JHHS entities. Requires ability to make autonomous decisions in assessing and managing compliance risk.

Required Licensure Certification, etc. For a BSN, requires an active RN license in good standing with the Maryland State Board of Nursing, or another State’s Board. For a JD, requires an active license to practice law, in good standing, from the Maryland State Board of Law Examiners or another State’s Board.