Director, Billing Compliance

				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 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 the Dana-Farber enterprise, 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.

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.

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

Qualifications:

* Bachelor's degree in Healthcare administration, management, or related field required. Master's degree in a related field preferred.
* 10 years of experience in healthcare billing compliance as well as demonstrated management experience required.
* Epic hospital billing (HB) and professional billing (PB) modules preferred.
* Cancer center experience preferred.
* Certified Coder (CCS, CPC, RHIT or RHIA) required.
* Health Care Compliance Association (HCCA) Certification in healthcare compliance (e.g., CHC) preferred.

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.

At 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 equally committed to diversifying our faculty and staff.  Cancer knows no boundaries and when it comes to hiring the most dedicated and diverse 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.

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Dana-Farber Cancer Institute