Director, Billing Compliance

Director, Billing Compliance Dana-Farber Cancer Institute Boston, MA Full Time Overview Reporting to the VP, Chief Compliance Officer with a dotted line reporting relationship to the VP, Revenue Performance Management, the Director of Billing Compliance is a strategic leader and subject matter expert responsible for ensuring the integrity, accuracy, and compliance of billing practices across the organization. The Director provides constructive oversight and mentorship to the Billing Compliance team. This role leads the development and execution of a robust billing compliance program focused on hospital technical and professional fee billing in compliance with internal policies and state, federal and local rules. The Director serves as a key 'second line of defense' in support of accurate and compliant operational processes. The Director works as a cross functional leader, partnering with clinical, administrative, and financial teams and participating in committees and projects to collaborate on setting standards and assuring best practices are followed across the organization. Responsibilities include leading routine monitoring, assessing for and identifying areas of risk assessments, conducting investigations, responding to audits, providing consultation/guidance, and sharing program findings with providers and leadership. 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 (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.

KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED:

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:

The job requires a bachelor's degree in healthcare administration, management, or a related field, with a preference for a master's degree. Candidates should have 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.

SUPERVISORY RESPONSIBILITIES:

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

PAY TRANSPARENCY STATEMENT

The hiring range is based on market pay structures, with individual salaries determined by factors such as business needs, market conditions, internal equity, and based on the candidate’s relevant experience, skills and qualifications. For union positions, the pay range is determined by the Collective Bargaining Agreement (CBA). $154,200.00 - $170,800.00 Dana-Farber Cancer Institute is an equal opportunity employer and affirms the right of every qualified applicant to receive consideration for employment without regard to race, color, religion, sex, gender identity or expression, national origin, sexual orientation, genetic information, disability, age, ancestry, military service, protected veteran status, or other characteristics protected by law. #J-18808-Ljbffr St. Cloud Orthopedics