Sr. Director Compliance & Training

We are seeking a Sr. Director Compliance & Training, who will direct the Office of Compliance Professional Fee Services and is responsible for all billing compliance and training programs for Johns Hopkins Medicine’s clinical care providers. The Senior Director is a member of the senior management team of the School of Medicine’s Clinical Practice Association (CPA) and the Office of Johns Hopkins Physicians. Responsible for strategic planning, implementation and direct and indirect management of all professional fee billing compliance activities. Works closely with CPA leadership, OJHP Leadership, School of Medicine (SOM) leadership, the Johns Hopkins University (JHU) General Counsel, Johns Hopkins Health System (JHHS), Legal Department and Corporate Compliance Department, JHHS physician entity leadership, Revenue Cycle leadership, and SOM clinical department directors and administrators.  Will ensure the Billing Quality Assurance compliance and training programs are appropriately coordinated and effective. Reports directly to the JHU Senior Assoc General Counsel & Chief Compliance Officer with a dotted-line report to the Chief Operating Officer, Office of Johns Hopkins Physicians/Executive Director CPA, and is the University’s senior subject matter expert on professional fee billing.  Physician entities included in the scope of responsibility include but are not limited to,

• JHUSOM: Clinical Practice Association (faculty practice plan)
• JHHS: Johns Hopkins Community Physicians, Johns Hopkins Regional Physicians, Johns Hopkins All Children’s Specialty Physicians, Johns Hopkins Personalized Care
• Johns Hopkins Executive Health

Specific Duties & Responsibilities

• Responsible for strategic planning and the development, expansion and viability of the Office of Compliance: Professional Fee Services and compliance and training programs to safeguard the reputation and billing integrity by SOM and JHHS clinical faculty, physicians, and other JHM providers. Oversees and manages an exemplary compliance program as a leading academic medical center.
• Develops, plans and is accountable for the professional fee billing compliance operations of JHM, working collaboratively with the JHU Chief Compliance Officer, JHU General Counsel, SOM Office of Research Administration, JHHS Compliance, JHHS Central Business Office, and JHHS Legal.
• Plans and creates all JHM 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 third-party insurers.
• Plans and creates all JHM programs and processes to ensure that items or services provided to patients are correctly billed by to insurers and other third-party 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).
• Plans and/or approves all billing compliance training programs for SOM clinical faculty, JHHS clinicians, JHM non-physician practitioners and billing office staff.
• Sets the priorities and agenda and with the physician chair, serves as co-chair of the CPA’s Compliance Committee.
• Evaluates clinical programs to ensure effectiveness and continually refines or adds to the scope and priorities based on internal initiatives and external regulations.
• Evaluates and promotes the use of innovative technologies and processes to enhance billing compliance, improve operations and facilitate efficient clinical practice.
• Represents the CPA/OJHP and/or JHM as a key member on special projects and strategic institutional initiatives.
• Provides timely audit reports of all JHHS clinicians to the JHHS Compliance Department.

• Responsible for the overall operation of the Office of Compliance: Professional Fee Services and compliance and training programs for SOM, which includes Compliance Action Plans for each clinical department.
• Develops policies, procedures and an organizational structure for billing in coordination with all related institutional entities and departments.
• Creates methods and processes for pre and/or post-billing compliance auditing of professional fee charges billed to insurance. Collaborates with the JHHS Corporate Compliance Office to create audit processes for professional billing.
• Proactively addresses JHHS compliance concerns and adjusts operational processes, as necessary, with a key focus on professional documentation that impacts hospital billing.
• Participates in developing JHM policies regarding clinical billing, patient registration and related operations.
• Develops and recommends for approval by the CP