Director of Professional Fee Compliance

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Job Responsibilities:

The Director of Professional Fee Compliance directs professional fee compliance activities for the Department of Corporate Compliance and is responsible for all billing compliance and training programs for Johns Hopkins Health System's clinical care providers. The Director is broadly responsible for strategic planning, implementation and direct and indirect management of all professional fee billing compliance activities.

The Director works closely with Johns Hopkins Health System (JHHS) physician practice leadership, JHHS Legal Department, and JHHS Revenue Cycle leadership to ensure that billing quality assurance compliance requirements and training programs are appropriately coordinated and effective. The Director reports directly to the JHHS Chief Compliance Officer, and is the JHHS senior subject matter expert on professional fee billing.

Physician entities included in the scope of responsibility include but are not limited to:

JHHS: Johns Hopkins Community Physicians, Johns Hopkins Regional Physicians, Johns Hopkins All Children's Specialty Physicians, Johns Hopkins Personalized Care, and

Johns Hopkins Executive Health.

Role Accountabilities Include

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  Responsible for strategic planning and the development, expansion and viability of the Office of Compliance for Professional Fee Services and compliance and training programs to safeguard the reputation and billing integrity of services provided by JHHS physicians, and other JHHS clinicians.

  
  
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  Develops, plans and is accountable for the professional fee billing compliance operations of JHHS, working collaboratively with the JHHS Clinical Practice Leadership, JHHS Revenue Cycle and JHHS Legal.

  
  
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  Plans and creates all JHHS programs and processes to assess the level of knowledge and accuracy of professional fee billing, medical record documentation, and coding to adequately represent services billed to governmental payers.

  
  
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  Plans and creates all JHHS programs and processes to ensure that items or services provided to patients are correctly billed to governmental payors. Supports clinical and operational teams to build and implement new and non-traditional professional billing codes and associated clinical services (such as remote monitoring, asynchronous care, chronic condition management, and interprofessional consultation)

  
  
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  Plans and/or approves all billing compliance training programs for JHHS clinicians, JHHS non-physician practitioners and billing office staff

  
  
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  Sets the priorities for the annual, professional fee audit workplace

  
  
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  Evaluates clinical programs to ensure effectiveness and continually refines or adds to the score and priorities based on internal initiatives and external regulations.

  
  
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  Evaluates and promotes the use of innovative technologies and processes to enhance billing compliance, improve operations and facilitate efficient clinical practice.

  
  
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  Represents the JHHS Compliance Department as a key member on special projects and strategic institutional initiatives.

  
  
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  Provides timely audit reports of all JHHS clinician reviews to all appropriate stakeholders.

  
  
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  Presents professional fee audit results at various management and governance meetings throughout JHHS.

  
  

Qualifications:

• Bachelor's degree in relevant discipline required, Master's degree highly preferred
• Minimum of 10 years' experience in corporate compliance management
• Eight years directly related management and professional experience required, additional advanced education may substitute for some experience
• Certification as a medical billing and coding professional highly preferred
• Comprehensive knowledge of clinical billing regulations, clinical practice operations, and federal compliance guidelines for physicians, hospitals and third-party billing organizations required.
• Demonstrated leadership and emotional intelligence to navigate within a complex organization, communicate sensitive information to all levels of leadership, and promote and implement any required remediation to mitigate organizational risk and ensure compliance required.
• Demonstrated expertise in billing compliance, health care administration or consulting, internal auditing, and planning and implementation of new programs required.
• Excellent written and verbal communication skills, and significant experience in delivering presentations to all organizational levels required.
• Strong interpersonal skills and ability to relate effectively with people at all organizational levels. Demonstrated ability to facilitate collaborative relationships and effectively motivate others to adhere to all necessary requirements to mitigate compliance risk for individuals and the institution required.
• Ability to handle confidential and sensitive information in a discreet and professional manner and demonstrate sound and prudent judgment in all business dealings required.

Salary Range: Minimum $116,000 per year - Maximum $154,000 per year. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility.

JHM prioritizes the health and well-being of every employee. Come be healthy at Hopkins!

Diversity and Inclusion are Johns Hopkins Medicine Core Values. We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practice.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.