Director of Billing Compliance

The Director of Billing Compliance ensures the integrity and accuracy of billing practices within the organization. This role involves developing and implementing compliance programs that adhere to regulations and industry standards, focusing on hospital and professional billing compliance. The Director acts as the 'second line of defense' to ensure effective operational processes for accurate billing across our organization, collaborating with clinical, administrative, and financial teams. Responsibilities include preparing risk assessments, conducting investigations, responding to audits, and sharing program findings with providers and leadership. Additionally, the Director works with various departments to develop internal controls for managing billing risks and participates in committees and projects to collaborate on best practices.

Qualifications

Education Required	Education Preferred
Bachelor's Degree	Master's Degree

Area of Study Required	Area of Study Preferred
Health care administration, management or related field.	Related field.

Experience Required	Experience Preferred
10 years of experience in healthcare billing compliance as well as demonstrated management experience.	Epic hospital billing (HB) and professional billing (PB) modules. Cancer center experience.

License/Certification/Registration Required	License/Certification/Registration Preferred
Certified Coder (CCS, CPC, RHIT or RHIA).	Health Care Compliance Association (HCCA) Certification in healthcare compliance (e.g., CHC).

Responsibilities

Compliance Program Development: Designs and implements comprehensive billing compliance programs, including goals and objectives. Establishes policies and procedures to ensure adherence to regulatory and payer requirements. Monitors changes in healthcare regulations and updates compliance strategies accordingly.

Audit and Monitoring: Conducts regular review of billing practices to identify and rectify discrepancies. Develops and implements monitoring systems and metrics to ensure ongoing compliance. Prepares and presents review findings to senior management and recommends corrective actions.

Training and Education: Develops curriculum and delivers clinical documentation, coding and billing education programs for physicians, Advanced Practice Providers (APPs), infusion nurses, etc. Ensures that all relevant personnel are informed of regulatory updates as well as compliance policies and procedures and that the information is delivered in a manner that the audience can relate to.

Risk Management: Identifies potential compliance risks and develops strategies to mitigate them. Investigates and responds to instances of suspected non-compliance and develop corrective action plans as needed. Collaborates with legal and risk management teams to address compliance issues as appropriate.

Reporting and Documentation: Maintains accurate records of compliance activities and reviews results as well as corrective actions. Prepares reports for regulatory bodies and senior management, including the Compliance Oversight Committee, the Billing Compliance Workgroup, and the Board Audit and Compliance Committee, as appropriate.

Collaboration and Communication: Works closely with clinical, administrative, and financial teams across the Enterprise to ensure seamless integration of compliance practices. Collaborates with Billing Compliance peers at clinical partners to ensure that messaging to providers is aligned. Serves as the primary point of contact and subject matter expert for billing compliance inquiries.

Supervises Staff: Hires and develops team members with the capabilities to achieve organizational goals. Defines and communicates clear expectations, provides regular constructive feedback, and evaluates performance against objectives. Oversees team's compliance with organizational policies and procedures. Monitors work for efficiency, effectiveness, and quality. Mentors and coaches staff, facilitating training opportunities and supporting career growth. Works with senior management and Human Resources to address performance issues, as appropriate. Promotes and fosters a healthy and productive work environment within the team and with groups across the Institute.

Knowledge, Skills and Abilities

Extensive knowledge of ICD-10-CM and CPT/HCPCS coding as well as healthcare billing regulations and reimbursement systems.

In-depth knowledge of healthcare regulations, including Medicare and Medicaid billing and medical record documentation requirements.

Strong understanding of complex hospital and professional billing compliance as well as revenue cycle operations.

Advanced knowledge of reimbursement systems and an understanding of basic random sampling and statistical analysis.

Familiarity with healthcare compliance standards such as HIPAA and the False Claims Act.

Exceptional verbal and written communication skills and ability to communicate complicated and potentially concerning matters to peers, senior leaders and stakeholders.

Ability to build and maintain relationships with internal stakeholders, including disease center teams, senior leadership, and peers at external clinical partners.

Ability to lead and manage a team, providing guidance and support to ensure compliance objectives are met.

Aptitude for identifying issues and developing effective solutions to address billing compliance challenges.

Ability to think critically and make informed decisions regarding billing compliance strategies.

Awareness of current trends and changes in healthcare billing and compliance regulations.

Strong organizational and project management skills, with an attention to detail, to track multiple priorities of highly detailed information and to evaluate all aspects of a problem or opportunity.

Supervisory Responsibilities


Yes	Directly supervises Billing Compliance program employees including managers and reviewers for facility and professional fee billing.

Pay range is $75-90/hr depending on level of experience.