17 days old

Director Billing Compliance

Cleveland Clinic
Cleveland, OH 44114

Job Summary:

The Director of Billing Compliance directs the system-wide billing compliance program, which is integral to Cleveland Clinic’s Corporate Compliance & Ethics Program. Responsible for coordinating and monitoring department-specific coding and billing audits on an ongoing basis and conducts or directs investigations into related compliance concerns. Provides guidance on the application of coding, documentation and billing regulations and standards related to professional and hospital reimbursement, and interacts with government regulators and other agency representatives. Attends the Corporate Compliance Committee meetings.

 

Responsibilities:

  • Under the direction of the Executive Director of the Corporate Compliance Department, collaborates with other departments to investigate and resolve reported compliance concerns related to billing compliance.
  • Communicates to the Executive Director of Corporate Compliance any matter that potentially requires external reporting or is deemed potentially illegal, unethical or otherwise inappropriate.
  • Assists clinical institutes, Revenue Cycle Management, and hospital leaders in conducting compliance risk assessments of their billing and coding operations and the implementation of annual work plans to ensure that identied risks are appropriately mitigated. 
  • Facilitates, promotes and supports their implementation of compliance initiatives, documentation and reporting obligations. 
  • Actively participates as a compliance resource and consultant to other departments on the application of coding, documentation and billing regulations and standards related to professional and hospital reimbursement. 
  • Attends and presents to the CCHS Corporate Compliance Committee and other audiences as requested.
  • Conducts and documents audits and reviews of billing operations to assess for compliance with regulatory requirements. 
  • Collaborates with departments to ensure the implementation of written policies and procedures that reinforce current Federal and State statutes and regulations regarding the submission of claims and Medicare cost reports.  
  • Maintains current knowledge of official coding and billing guidelines, regulations and national trends pertaining to Center for Medicare and Medicaid Services (CMS) and Department of Health and Human Services (HHS) requirements as they relate to compliance operations. 
  • Maintains awareness of federal, state and local coding and billing compliance issues to monitor their relevance to the CCHS Compliance program.  Interacts with government reglulators and other agency representatives.
  • Supervises and manages direct reports.
  • Other duties as assigned.

    Education:

    • Bachelors degree required.

      Certifications:

      • Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), Certified Coding Specialist - Physician (CCS-P) through the American Health Information Management Association (AHIMA) or Certified Professional Coder (CPC) through the American Academy of Professional Coders (AAPC) required.
      • Certification in Health Care Compliance (CHC) through the Health Care Compliance Association (HCCA) preferred.

        Complexity of Work:

        • Advanced knowledge of Federal, State and local health care laws and regulations, particularly CMS and other federally funded program regulations and standards and their application to professional and hospital coding, billing, and reimbursement in both inpatient and outpatient settings.
        • Experience working with and safeguarding highly confidential and sensitive information.
        • Reputation for integrity and willingness to work with higher levels of management.
        • Ability to develop positive working relationships across all levels of the organization.
        • Unbiased approach to situations, combined with non-judgemental attitude.
        • Demonstrated knowledge of coding, billing and documentation requirements for both inpatient and outpatient settings.
        • Ability to research and interpret regulatory guidance.
        • Ability to manage demanding workload and adapt to changing priorities.
        • Ability to identify and address multiple perspectives on issues. 
        • Ability to lead investigations into root-cause identification and subsequent process-improvement intiatives. 
        • Proficiency in Microsoft Excel and PowerPoint.
        • Ability to work in Electronic Medical Records (e.g. Epic) and other data systems.

          Work Experience:

          • A minimum of 7 years experience in health care coding, billing and third party reimbursement required.
          • A minimum of 1 year of management experience required. 
          • Past experience involving the application of billing and coding laws, standards and regulations within healthcare operations, articulating  complex information into understandable terms and effectively communicating at all levels within the organization.

            Physical Requirements:

            • Work typically performed in an office setting with frequent use of computers and telephones.
            • Includes frequent walking and driving of varying distances on campus and at off-site locations.

              Personal Protective Equipment: 

              • Follows Standard precautions using personal protective equipment.


                The policy of Cleveland Clinic and its system hospitals (Cleveland Clinic) is to provide equal opportunity to all of our employees and applicants for employment in our tobacco free and drug free environment. All offers of employment are followed by testing for controlled substance and nicotine. Job offers will be rescinded for candidates for employment who test positive for nicotine. Candidates for employment who are impacted by Cleveland Clinic’s Smoking Policy will be permitted to reapply for open positions after 90 days. Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic facility.

                Cleveland Clinic is pleased to be an equal employment employer: Women/Minorities/Veterans/Individuals with Disabilities",

Categories

Posted: 2020-05-20 Expires: 2020-06-19

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Director Billing Compliance

Cleveland Clinic
Cleveland, OH 44114

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