Program Director

Position: Program Director

Location: Mid-Atlantic

Work Requirements: 95% remote / In-person to J29 or client meetings (Baltimore, MD), as needed based. This role will require quarterly travel to the Millersville, MD J29 office for (as estimated) four to five days per quarter.

FLSA Status: Full-Time, Exempt

Overview:

J29, Inc. (J29) has been supporting commercial, State, and Federal health and human service programs since company inception in 2017 as a healthcare management consulting company. Our team of 260 employees focuses on providing processing, review, and analysis of medical claims, records, data, and audits between areas of compliance, policy, and clinical expertise. Our team is experienced in program, payment, provider, and patient integrity as we continue to support advanced programs of policy, clinical requirements, and compliance measures at the commercial, State, and Federal levels.

J29 was founded to be an employee-centric company that prioritizes the well-being and value of its employees. Our mission is to empower our employees to do great things for the benefit of those that need it most. The J29 mission supports not only our health and human service programs, but also the philanthropy efforts of our team. We are proud to continue our support to non-profit groups with critical missions as J29 continues to grow.

Related to this Program Director position, J29 supports the Centers for Medicare & Medicaid Services (CMS) in their efforts surrounding the National Correct Coding Initiative (NCCI). NCCI promotes national correct coding methodologies and works to reduce improper coding, with the overall goal of reducing improper payments of Medicare Part B and Medicaid claims. This role must be familiar with the intentions and purpose of the NCCI program.

Position:

J29 is looking to hire a Program Director to manage, direct, oversee, and lead J29’s contracted support to CMS. This position will assume and direct a team of J29 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 J29’s leadership group – a team of Directors and above, responsible for bridging any gaps in J29’s cultural intention, mission, and vision as it relates to their respective teams.

Role & Responsibilities:

• Responsible for assuming timely and quality management of J29’s 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 J29’s team, including both J29 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 J29 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 team’s 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 (J29) policies and procedures.
• Utilize highly persuasive communication skills for team interaction, leadership meetings, online facilitation, public speaking, and presentations.

Experience / Expertise:

• 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+ of direct reports across medical coding, clinical, data, or other healthcare compliance / policy experience.
• 9+ years’ experience in interpreting/coding Healthcare Common Procedure Coding System (HCPCS)/ Current Procedural Terminology (CPT) codes and coding conventions
• 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
• 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 bachelor’s degree from an Accredited University or College

 J29, Inc. is committed to hiring and retaining a diverse workforce. We are proud to be an Equal Opportunity/Affirmative Action Employer, making decisions without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, veteran status, disability, or any other protected class.  J29, Inc. is a proud Veteran friendly employer.