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Job Details

Compliance Program Integrity Coordinator

Requisition #: 183623
Location: Johns Hopkins Health Care, Hanover, MD 21076
Category: Non-Clinical Professional
Work Shift: Day Shift
Work Week: Full Time (40 hours)
Weekend Work Required: No
Date Posted: March 26, 2019

Johns Hopkins Health System employs more than 20,000 people annually. Upon joining Johns Hopkins Health System, you become part of a diverse organization dedicated to its patients, their families, and the community we serve, as well as to our employees. Career opportunities are available in academic and community hospital settings, home care services, physician practices, international affiliate locations and in the health insurance industry. If you share in our vision, mission and values and also have exceptional customer service and technical skills, we invite you to join those who are leaders and innovators in the healthcare field.

The Program Integrity Coordinator reports directly to the Program Integrity Supervisor. Principal areas of responsibility are to oversee the organization’s Privacy activities. Works in collaboration with Hopkins HIPAA Office, JHHC Corporate, and JHHC’s lines of business leaders (USFHP, PPMCO, and EHP Administrations) in identifying, prioritizing, preventing and/or correcting privacy and security risks.

Responsibilities include:

  • Identifying and referring areas of alleged fraud, waste, abuse and/or misappropriation to JHHC Compliance Auditor staff for further investigation
  • Providing privacy training to JHHC workforce members
  • Accurate and timely data entry of cases into the Departmental tracking and Disclosure databases
  • Reviewing and determining HIPAA compliance of Plan members’ standing and/or unique/one-time authorization forms
  • Communicating with Plan members and other external customers regarding HIPAA non-compliant authorizations
  • Processing of all EHP and PP unique/one-time authorizations and Explanation of Benefit requests
  • Performs departmental confirmatory phone audits (survey member receipt of good/services) and disclosure audit
  • Reviewing and logging of all inappropriate disclosure referrals and the referral to the Level II Coordinator of any that rise to the level of a breach investigation
  • Assists Level II Coordinator in collection of information related to Breach and/or privacy investigations

Requirements:

  • Associates Degree in paralegal studies, health care administration, nursing, or a related field; In lieu of Associates degree a minimum of 5 years managed care experience may be substituted; Bachelor’s degree strongly preferred
  • A professional level of knowledge in health care regulatory requirements and compliance program elements; Knowledge of organizational claims systems and policies is strongly preferred
  • Knowledge of standard health care concepts and practices acquired during 2 or more years of experience in a health care environment
  • Proficient at research and capable of understanding legal statutes, regulations and legislative edicts
  • Prior work experience in privacy or fraud and abuse is preferred
  • Strong analytical skills including the ability to understand difficult contractual requirements, regulatory statutes, Office of Inspector General and Office of Civil Rights Privacy guidances, and accreditation standards
  • Excellent interpersonal and communication (written and oral) skills and the ability to translate complex legal directives into written reports, policies, and workflows that are straightforward and comprehensible
  • Strong computer skills; Outlook, Excel, Access, and PowerPoint

Johns Hopkins Health System and its affiliates are Equal Opportunity/Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity, sex, age, national origin, disability, protected veteran status, and or any other status protected by federal, state, or local law.

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