Director Billing Compliance
Overview
The Director of Billing Compliance at Dana-Farber Cancer Institute is a strategic leader responsible for ensuring the integrity, accuracy, and compliance of billing practices across the organization. Reporting to the VP, Chief Compliance Officer, this role also serves as a key 'second line of defense' in support of accurate and compliant operational processes.
Responsibilities
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.
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.
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.
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.
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.
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 (e.g., Boston Children’s Hospital), 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.
Qualifications
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
Minimum Job Qualifications
Bachelor's degree in healthcare administration, management, or a related field, with a preference for a master's degree
At least 10 years of experience in healthcare billing compliance and management, with additional experience in Epic hospital and professional billing modules or cancer center operations preferred
Certification as a coder (e.g., CCS, CPC, RHIT, or RHIA) is mandatory, while healthcare compliance certification (e.g., CHC) is desirable
Pay
$154,200.00 - $170,800.00 per year