Program Director

Program Director, Remote

• Full-time
• Remote (prefer candidates located in Mid-Atlantic due to quarterly travel to Maryland office)
• Due to our government client requirements, we can only consider US Citizens for this position
  

Description

Seeking a Program Director to manage, direct, oversee, and lead our client's contracted support to CMS. This position will assume and direct a team of staff and subcontractor personnel across areas of expertise between clinical, medical coding, and Medicare / Medicaid policy.

Included in the day-to-day responsibilities of this role will also be leadership responsibility for this individual to sit on and provide collaborative support to our client's leadership group responsible for bridging any gaps in our client's cultural intention, mission, and vision as it relates to their respective teams.

Responsibilities

• Responsible for assuming timely and quality management of the contractual program supporting CMS in the effort to minimize fraud, waste, and abuse in medical claims processing.
• Serve as the point of management and leadership to our client's team, including both internal staff and outside vendor staff.
• Leverage knowledge and expertise in interpreting healthcare procedures, services, drugs, and supplies into medical code sets under NCCI program.
• Oversee and provide continuous review thyself of the current NCCI PTP (Procedure to Procedure), MUE (Medically Unlikely Edits) and AOC (Add-On Code) edit programs and to further develop, improve and expand those programs to prevent improper payments.
• Ensure that contracted deliverables are met with the client in a timely and quality manner, working with other cross-subject matter experts across the team to ensure that program expectations are best represented.
• Evaluate claim information to ensure that NCCI accurately reflects CMS payment and coverage policies and procedures, work with other team experts to assign duties and manage responsibilities that ensure that policies and procedures are met.
• Collaborate with both CMS stakeholders on expectations and priorities of program, and work with applicable internal and vendor team resources to make sure coding, research, reporting, and analysis are assigned and conducted to the best of the teams ability.
• Maintain the role of comfortability working and engaging with CMS leadership daily to provide strong customer service and collaborative approach through all communications.
• Ability to research and analyze data, draw conclusions, and resolve issues; read, interpret, and apply policies, procedures, laws, and regulation.
• Continue to prioritize how to enhance and enrich the corporate brand through leadership and management skills shared with the team, external personnel, and upper management to position the organization favorably with employees, prospective staff, partners, and customers.
• Responsible for adhering to all corporate or client policies and processes, including timelines and milestones, and working with team to ensure that there is education and comfort of such corporate policies and procedures.
• Utilize highly persuasive communication skills for team interaction, leadership meetings, online facilitation, public speaking, and presentations.

Requirements

• Effective and demonstrated experience in leadership and management skills, including the ability to front-line manage, performance improve, conflict prevention, and de-escalation amongst team members.
• Proven ability to collaborate with other leaders across the company to improve team culture and alignment to company values and mission.
• 10+ years of experience managing a team of 6+ direct reports across medical coding, clinical, data, or other healthcare compliance / policy experience.
• 8+ years of proven and strongly-directive experience working in process with Correct Coding Initiatives, in particular the National Correct Coding Initiative (NCCI).
• 6+ years project management experience overseeing large projects, budgets, and staff.
• 4+ years directly managing and/or overseeing a Federal contract, including direct lines of communication to active Federal clients.
• 9+ years experience in interpreting/coding Healthcare Common Procedure Coding System (HCPCS)/ Current Procedural Terminology (CPT) codes and coding conventions.
• Experience working with Medicare and Medicaid payment, coverage, and coding policies included with the demonstrated experience of leading Federal and State stakeholder engagement on expertise tracks that align to the mentioned policies and subject matter groups.
• 4+ years of experience working in or with Azure SQL database environments.
• Candidate is/should be considered an advanced expert as it related to Microsoft Office 365 (O365) applications, such as Outlook, SharePoint, Teams, Excel, OneDrive, and Word.
• Specifically included is the use of Microsoft Excel in this position (include V-Lookup, pivot table creation, concatenation, etc.)

Education/Certification

• Current medical coding certification held in active and positive standing (i.e., RHIA, RHIT, CCS, CCS-P, CPC, or CPC-H minimum).
• Educational requirement of a bachelors degree from an Accredited University or College

Please Note:

• Only those individuals selected for an interview will be contacted.
• No calls, inquiries, or Third-Party Vendors please.
• We are an equal opportunity employer. We encourage applications from candidates of all backgrounds and experiences. (The ACI Group is unable to sponsor H1B Visas).
• $1000 Referral Bonus - www.aci.com.

Since 1988, The ACI Group, a Baltimore-based staffing firm, has been committed to hiring the industry's leading professionals, and presenting exciting career opportunities. We have access to varied types of contract, permanent and contract-to-perm positions and offer a choice of employment options including a full benefits package.