JOB SUMMARY
Director Billing, Regulatory, and Provider Coding Compliance is responsible for planning, developing, and enforcing compliance programs for Baylor Scott and White Health (BSWH), which may include varied compliance functions and programs such as provider regulatory compliance, coding compliance, compliance hotline services, conflict of interests, education, and other compliance activities. Leads the development of compliance programs to prevent and detect non-conformance to laws, regulations, standards, and BSWH policies and ensures the implementation for assigned area of the organization. Develops and implements strategies, policies, procedures, and practices that establish BSWH standards for compliance. Ensures compliance to all applicable laws, regulations, and accreditation standards, such as the Joint Commission, Centers for Medicare and Medicaid (CMS), National Committee for Quality Assurance (NCQA), Health Insurance Portability and Accountability Act (HIPAA), and Occupational Safety and Health Administration (OSHA). Responds and reacts to changes and developments in laws or the regulatory environment that might affect BSWH compliance and implements necessary changes. Investigates, audits, and resolves alleged violations or incidents of nonconformance and verifies that compliance deficiencies have been corrected. Provides key support and regular reporting to the Audit and Compliance Committee of the BSWH Board. May develop and implement employee compliance training curriculum. Collaborates closely with executive leadership, operations, legal, risk management, finance, and Information Security to identify and resolve compliance issues in accordance with overall BSWH business objectives.
A system Director translates and implements strategic plans and objectives for area of responsibility. Makes final decisions on operational matters and ensures achievement of objectives. Recommends policies and organizational changes for area. Plans and executes projects and initiatives that meet annual objectives. Erroneous decisions at this level tend to have a negative impact on the success of the area, business unit, and possibly the overall organization's operations. Plans and directs the operations of a department or area, with responsibility for staffing, processes, budgets, and costs of the unit. Leads and advises subordinate(s) to meet schedules, resolve technical problems, and monitor performance. Has a larger, more complex organization or functional area than a manager. Often has one or more managers or supervisors reporting to the role.
ESSENTIAL FUNCTIONS OF THE ROLE
1. Directs billing, regulatory and provider coding compliance for assigned area of responsibility for BSWH.
2. Recommends and implements strategic and operational plans and priorities for compliance programs aligned to BSWH overall business objectives.
3. Directs the identification and evaluation of emerging compliance risks by utilizing regulatory guidance, data analytics, and other compliance best practices.
4. Leads the resolution of compliance issues for physicians, advanced practice providers, practice administrators, and other physician practice staff.
5. Plans and directs compliance audits to assess compliance and communicates audit findings and recommendations.
6. Directs regulatory research and provides written guidance on regulatory changes and interpretive guidance on billing or regulatory concerns.
7. Develops and presents provider coding compliance progress and summary reports or presentations to physicians and executive leadership.
8. Promotes consistency in the provider coding audit and education processes for all employed physicians and advanced practice providers.
9. Leads a multidisciplinary team to evaluate regulatory requests, audits, and denials and recommend necessary process changes.
10. Tracks the resolution of corrective actions agreed to by senior leadership in response to compliance audits or investigations and provides summary reports of activity.
11. Assist the BSWH Office of Corporate Ethics and Compliance in identifying, evaluating and resolving provider-related potential conflict of interests. Identifies potential areas of compliance vulnerability and risk; develops/implements corrective action plans for resolution of problematic issues and provides general guidance on how to avoid or deal with similar situations.
KEY SUCCESS FACTORS
- Bachelor's degree in healthcare administration, business, or related field preferred.
2. 5+ years of healthcare compliance, provider coding, regulatory operations, or related area.
3. 1+ years of experience in a leadership role.
4. Experience leading a compliance program in a large, complex organization.
5. Knowledge of healthcare compliance practices and regulatory requirements.
6. Knowledge of coding processes and coding compliance.
7. Experience conducting healthcare compliance audit investigations and addressing non-compliance.
8. Healthcare compliance professional certification preferred, such as Certified in Healthcare Compliance (CHC), Certified Information Privacy Professional (CHPC), Certified Healthcare Research Professional (CHRC), and Certified Healthcare Compliance Fellow (CHC-F).
9. Coding certification with AAPC or AHIMA preferred.
10. Excellent written, verbal, and presentation skills.BENEFITS
Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include:
- Immediate eligibility for health and welfare benefits
- 401(k) savings plan with dollar-for-dollar match up to 5%
- Tuition Reimbursement
- PTO accrual beginning Day 1
Note: Benefits may vary based upon position type and/or level
QUALIFICATIONS
- EDUCATION - Bachelor's
- EXPERIENCE - A minimum of 5 years experience in management required
- EXPERIENCE - A minimum of 6 years experience required
- CERTIFICATION/LICENSE/REGISTRATION -
Cert in Healthcare Compliance (CHC)
