- Bachelors Degree in an appropriate field is required. Masters Degree is preferred. Post graduate certificate in Health Care Compliance is optional.
- Minimum of 7 years experience working in payer compliance with experience in Medicare Advantage, Medicaid managed care, TriCare and commercial (self-funded and fully insured) preferred.
- Minimum of 3 years experience as a Health Plan Compliance Officer or comparable role.
Executive Director of Compliance - Hanover, United States - Johns Hopkins Health Plans
Description
Summary
The Executive Director of Corporate Compliance and Regulatory Affairs (Exec. Director) at Johns Hopkins Health Plans (JHHP) reports to the Johns Hopkins Health System (JHHS) Chief Compliance Officer (and reports via a matrix relationship to the President of JHHP). The Exec. Director is responsible for the development, implementation, communication, and monitoring of all compliance activities and regulatory guidance for the Plans four payer lines of business, consisting of Medicare Advantage, Medicaid managed care, the Department of Defenses TriCare program and commercial employer group (self-funded). The Exec. Director also provides compliance and regulatory guidance to JHHPs Solutions line of business and any emerging business that JHHP develops.
The Exec. Director is responsible for assessing compliance risk and mitigation strategies for the health plans administered by JHHP. This activity is done by following the Federal Sentencing Guidelines of an Effective Compliance Program (Federal Sentencing Guidelines) as well as any plan specific contractual or regulatory requirements. Such activities include the development of Compliance Plans with auditing and monitoring activities of key business and/or risk areas as well as the supervision of staff to perform these duties. The Exec. Director must possess knowledge and understand the specific contractual and regulatory requirements for each payer line of business and be able to advise leadership, Board of Directors and staff on regulatory risk and mitigation.
The Exec. Director is responsible for the development and socialization of Compliance Plans and monitoring adherence to these Plans. The Exec. Director is responsible for the supervision and development of department staff who work as compliance/regulatory subject matter experts and execute on monitoring and auditing activities of applicable Compliance Plans. The Exec. Director is also responsible for the management and resolution of regulatory complaints and education of staff and leadership about current and emerging regulatory requirements.
Work Experience: