Director Of Billing & Coding Compliance

5+ years

Not Disclosed

Dallas

10 Nov. 23, 2024

Job Description

Job Type: Full Time Education: B.Sc./ M.Sc./ M.Pharm/ B.Pharm/ Life Sciences/ B.sc/ IT/ B.tech/ MBA Skills: Causality Assessment, Clinical SAS Programming, Communication Skills, CPC Certified, GCP guidelines, ICD-10 CM Codes, CPT-Codes, HCPCS Codes, ICD-10 CM, CPT, HCPCS Coding, ICH guidelines, ICSR Case Processing, Interpersonal Skill, Labelling Assessment, MedDRA Coding, Medical Billing, Medical Coding, Medical Terminology, Narrative Writing, Research & Development, Technical Skill, Triage of ICSRs, WHO DD Coding

Job Title: Director of Billing, Regulatory, and Provider Coding Compliance

Job Summary

The Director of Billing, Regulatory, and Provider Coding Compliance is responsible for planning, developing, and enforcing comprehensive compliance programs at Baylor Scott and White Health (BSWH). This role encompasses various compliance functions, including provider regulatory compliance, coding compliance, compliance hotline services, conflict of interest management, education initiatives, and other compliance activities. The Director will lead the development of programs aimed at preventing and detecting non-conformance with laws, regulations, standards, and BSWH policies. This position ensures compliance with all applicable laws and accreditation standards such as those set by the Joint Commission, Centers for Medicare and Medicaid Services (CMS), National Committee for Quality Assurance (NCQA), Health Insurance Portability and Accountability Act (HIPAA), and Occupational Safety and Health Administration (OSHA). The Director will respond to changes in the regulatory environment that may impact BSWH compliance and implement necessary adjustments. Additionally, the role involves investigating and resolving alleged violations or incidents of nonconformance while verifying that compliance deficiencies have been addressed. Regular reporting to the Audit and Compliance Committee of the BSWH Board is also a key responsibility.

Essential Functions

Compliance Direction: Oversee billing, regulatory, and provider coding compliance for assigned areas within BSWH.
Strategic Planning: Recommend and implement strategic and operational plans for compliance programs that align with BSWH's overall business objectives.
Risk Identification: Identify and evaluate emerging compliance risks using regulatory guidance, data analytics, and best practices.
Issue Resolution: Lead efforts to resolve compliance issues affecting physicians, advanced practice providers, practice administrators, and related staff.
Audit Planning: Plan and direct compliance audits to assess adherence to regulations; communicate findings and recommendations.
Regulatory Research: Conduct regulatory research and provide written guidance on changes affecting billing or regulatory concerns.
Reporting: Develop and present progress reports on provider coding compliance to physicians and executive leadership.
Education Promotion: Ensure consistency in provider coding audit processes and educational initiatives for employed physicians and advanced practice providers.
Multidisciplinary Collaboration: Lead a team to evaluate regulatory requests, audits, denials, and recommend necessary process changes.
Corrective Action Tracking: Track resolutions of corrective actions agreed upon by senior leadership following audits or investigations.
Conflict of Interest Management: Assist in identifying, evaluating, and resolving potential conflicts of interest related to providers.

Key Success Factors

Bachelor’s degree in healthcare administration, business, or a related field preferred.
Minimum of 5 years of experience in healthcare compliance, provider coding, or regulatory operations; 1+ years in a leadership role preferred.
Proven experience leading a compliance program within a large organization.
In-depth knowledge of healthcare compliance practices and regulatory requirements.
Familiarity with coding processes and coding compliance standards.
Experience conducting healthcare compliance audits and addressing non-compliance issues.
Preferred certifications include Certified in Healthcare Compliance (CHC), Certified Information Privacy Professional (CHPC), Certified Healthcare Research Professional (CHRC), or Certified Healthcare Compliance Fellow (CHC-F).
Coding certification from AAPC or AHIMA is preferred.
Excellent written, verbal communication, and presentation skills.

Benefits

Our competitive benefits package includes:

Immediate eligibility for health and welfare benefits
401(k) savings plan with a dollar-for-dollar match up to 5%
Tuition reimbursement
PTO accrual beginning on Day 1
(Note: Benefits may vary based on position type or level.)

Qualifications

Education: Bachelor’s degree required.
Experience: Minimum of 5 years in management; at least 6 years of relevant experience required.
Certification: Certification in Healthcare Compliance (CHC) is required.

This position offers an opportunity to lead critical compliance initiatives within a dynamic healthcare environment. If you meet the qualifications and are committed to enhancing healthcare compliance standards, we encourage you to apply.

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Director Of Billing & Coding Compliance

Job Description

Job Summary

Essential Functions

Key Success Factors

Benefits

Qualifications

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