Program Director

The ACI Group - Baltimore, MD

Full-time - Senior

Baltimore, MD

Professional, Scientific, and Technical Services

About the position

The Program Director will manage and lead a team providing contracted support to the Centers for Medicare & Medicaid Services (CMS). This role involves overseeing various areas of expertise, including clinical, medical coding, and Medicare/Medicaid policy, while ensuring the timely and quality management of the program. The Program Director will also collaborate with CMS leadership and internal teams to enhance the corporate brand and ensure compliance with policies and procedures.

Responsibilities

• Manage and direct the contractual program supporting CMS to minimize fraud, waste, and abuse in medical claims processing.
• Serve as the point of management and leadership for both internal staff and outside vendor staff.
• Interpret healthcare procedures, services, drugs, and supplies into medical code sets under the NCCI program.
• Oversee and improve NCCI edit programs to prevent improper payments.
• Ensure timely and quality delivery of contracted deliverables to the client.
• Evaluate claim information to ensure compliance with CMS payment and coverage policies.
• Collaborate with CMS stakeholders on program expectations and priorities.
• Maintain strong customer service and communication with CMS leadership.
• Research and analyze data to resolve issues and apply relevant policies and regulations.
• Enhance corporate brand through effective leadership and management skills.

Requirements

• 10+ years of experience managing a team of 6+ direct reports in medical coding, clinical, data, or healthcare compliance/policy.
• 8+ years of experience with Correct Coding Initiatives, particularly the National Correct Coding Initiative (NCCI).
• 6+ years of project management experience overseeing large projects, budgets, and staff.
• 4+ years of experience managing a Federal contract with direct communication to active Federal clients.
• 9+ years of experience interpreting/coding HCPCS/CPT codes and coding conventions.
• Experience with Medicare and Medicaid payment, coverage, and coding policies.
• 4+ years of experience working with Azure SQL database environments.
• Advanced expertise in Microsoft Office 365 applications, especially Excel.

Nice-to-haves

• Current medical coding certification (RHIA, RHIT, CCS, CCS-P, CPC, or CPC-H).
• Bachelor's degree from an accredited university or college.

Benefits

• $1000 Referral Bonus
• Full benefits package including varied types of contract, permanent, and contract-to-perm positions.