Why Join Us:
• We value the role each team member plays in helping us deliver on our mission of making life better for children.
• We take pride in providing a rich and rewarding career opportunities that enable team members to reach their highest potential.
• We are nationally ranked in all 10 pediatric specialties by U.S. News & World Report and are recognized for quality care in every specialty.
• Named for nine consecutive years as one of the 150 Best Places to Work in Healthcare by Becker’s Hospital Reviews. We were chosen based on our robust benefits, wellness initiatives, professional development opportunities and work environment that promotes employee collaboration and satisfaction.
About the Role:
The Director of Billing Compliance directs a broad and comprehensive program that manages billing compliance auditing and monitoring, due diligence billing compliance reviews, billing compliance education and corrective action coordination, and external payor program and program integrity audits. This program work helps to ensure that CHST and its affiliates and corporate entities are in compliance with all applicable billing compliance laws, rules and regulations, and that Hospital’s policies, procedures and Code of Conduct are being followed. The Director of Billing Compliance contributes to the success of Hospital’s mission and programs by minimizing its billing compliance risks and vulnerability to violations of complex state and federal laws and regulations.
Responsibilities:
• Develops and oversees a system for uniform handling of potential billing compliance concerns and investigations
• Designs and develops risk-based technical and professional billing compliance auditing program.
• Serves as the chair of the CHST Billing Compliance subcommittee and will support other CHST Compliance governance committees and functions as necessary.
• Oversees the design, development, documentation, and provision of education programs to support billing compliance requirements; identifies topics for education focus based on audit findings.
• Supervises a staff of up to 5 individuals including Compliance Partners, Program Coordinators and Compliance Analysts.
• Monitors billing practices and serves as point person for external billing audit activity for program integrity.
• Maintains appropriate liaison with state and federal law enforcement and regulatory agencies and professional compliance associations to assure awareness and early detection and prevention of potential risks and vulnerabilities in Children’s Health programs.
Requirements:
• At least 10 years’ experience in a healthcare / hospital setting, preferably to include pediatric and/or academic medical center experience.
• At least 5 years’ experience in hospital and/or professional medical practice group billing, revenue cycle, HIM, or coding
• At least 2 years direct experience in compliance and/or billing/revenue cycle compliance
• Knowledge of EPIC, Texas Medicaid, Health Plan claims/compliance
• Four-year Bachelor’s degree and/or equivalent experience is required. Graduate degree preferred.
• Healthcare Compliance or equivalent Corporate Compliance Certification (ex. CHC) is required upon hire.
• Certification as a Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Coding Associate (CCA), or relevant Revenue Cycle certification is required upon hire.
This position is required to be onsite part of the week.
Qualified professionals are to submit resumes to Jessica Simpson at jessica@conselium.com
Published by Conselium Executive Search, the global leader in compliance search.
