Director Billing Compliance

Director Of Billing ComplianceReporting 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.Located in Boston and the surrounding communities, Dana-Farber Cancer Institute is a leader in life changing breakthroughs in cancer research and patient care. We are united in our mission of conquering cancer, HIV/AIDS, and related diseases. We strive to create an inclusive, diverse, and equitable environment where we provide compassionate and comprehensive care to patients of all backgrounds, and design programs to promote public health particularly among high-risk and underserved populations. We conduct groundbreaking research that advances treatment, we educate tomorrow's physician/researchers, and we work with amazing partners, including other Harvard Medical School-affiliated hospitals.The Director of Billing Compliance is responsible for:Compliance Program DevelopmentAudit and MonitoringTraining and EducationRisk ManagementReporting and DocumentationCollaboration and CommunicationSupervises StaffKnowledge, Skills, and Abilities Required:Extensive knowledge of ICD-10-CM and CPT/HCPCS coding as well as healthcare billing regulations and reimbursement systemsIn-depth knowledge of healthcare regulations, including Medicare and Medicaid billing and medical record documentation requirementsStrong understanding of complex hospital and professional billing compliance as well as revenue cycle operationsAdvanced knowledge of reimbursement systems and an understanding of basic random sampling and statistical analysisFamiliarity with healthcare compliance standards such as HIPAA and the False Claims ActExceptional verbal and written communication skills and ability to communicate complicated and potentially concerning matters to peers, senior leaders and stakeholdersAbility to build and maintain relationships with internal stakeholders, including disease center teams, senior leadership, and peers at external clinical partnersAbility to lead and manage a team, providing guidance and support to ensure compliance objectives are metAptitude for identifying issues and developing effective solutions to address billing compliance challengesAbility to think critically and make informed decisions regarding billing compliance strategiesAwareness of current trends and changes in healthcare billing and compliance regulationsStrong 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 opportunityMinimum 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.Patient Contact: NoneAt Dana-Farber Cancer Institute, we work every day to create an innovative, caring, and inclusive environment where every patient, family, and staff member feels they belong. As relentless as we are in our mission to reduce the burden of cancer for all, we are committed to having faculty and staff who offer multifaceted experiences. Cancer knows no boundaries and when it comes to hiring the most dedicated and compassionate professionals, neither do we. If working in this kind of organization inspires you, we encourage you to apply.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.