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 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 and 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, partnering with clinical, administrative, and financial teams to set standards and assure best practices across the organization.

Located in Boston and the surrounding communities, Dana-Farber Cancer Institute is a leader in life changing breakthroughs in cancer research and patient care, united in its mission of conquering cancer, HIV/AIDS, and related diseases.

Key Responsibilities

• Compliance Program Development: Designs and implements comprehensive billing compliance programs, establishes policies and procedures to ensure adherence to regulatory and payer requirements, and monitors changes in healthcare regulations.
• Audit and Monitoring: Conducts regular review of billing practices, develops monitoring systems and metrics, and presents findings to senior management with recommended corrective actions.
• Training and Education: Develops curriculum and delivers clinical documentation, coding and billing education for physicians, Advanced Practice Providers, infusion nurses, and others.
• Risk Management: Identifies compliance risks, investigates suspected non-compliance, and collaborates with legal and risk management teams.
• Reporting and Documentation: Maintains accurate records of compliance activities and prepares reports for regulatory bodies and senior management.
• Collaboration and Communication: Works closely with clinical, administrative, and financial teams and serves as the primary point of contact for billing compliance inquiries.
• Supervises Staff: Hires, develops, mentors, and evaluates team members, fostering a healthy and productive work environment.

Knowledge, Skills, and Abilities Required

• Extensive knowledge of ICD-10-CM and CPT/HCPCS coding, 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 and revenue cycle operations.
• Familiarity with healthcare compliance standards such as HIPAA and the False Claims Act.
• Exceptional verbal and written communication skills and the ability to build relationships with internal and external stakeholders.
• Strong organizational and project management skills with attention to detail.

Minimum Job Qualifications

Bachelor's degree in healthcare administration, management, or a related field (master's preferred). At least 10 years of experience in healthcare billing compliance and management, with 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; healthcare compliance certification (e.g., CHC) is desirable.

Salary/Pay Rate: $154,200.00 - $170,800.00 per year

Dana-Farber Cancer Institute is an equal opportunity employer.