Job Title & Specialty Area: Director Billing Compliance
Department: Compliance
Location: Dallas, TX
Shift: Monday through Friday from 8:00 a.m. to 5:00 p.m.
Job Type: Remote
Why Children’s Health?
At Children’s Health, our mission is to Make Life Better for Children, and we recognize that their health plays a crucial role in achieving this goal.
Through our cutting-edge treatments and affiliation with UT Southwestern, we strive to deliver an extraordinary patient and family experience, ensuring that every moment, big or small, contributes to their overall well-being.
Our dedication to promoting children’s health extends beyond our organization and encompasses the broader community. Together, we can make a significant difference in the lives of children and contribute to a brighter and healthier future for all.

SUMMARY:

The Director of Billing Compliance oversees and leads the Billing Compliance function of the Corporate Compliance program, primarily functioning as an independent and objective resource that reviews and evaluates billing compliance issues within Children’s Health System of Texas (CHST), its Foundation and corporate affiliates and related entities. This position 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 Children’s Health policies, procedures and Code of Conduct are being followed. The Director of Billing Compliance is authorized access to all necessary records and personnel, to conduct such audits, inquiries or investigations as necessary and to implement all necessary actions, with the approval of the Vice President, Deputy Chief Compliance and Audit Officer, to assure achievement of the billing compliance program objectives as part of an overall effective compliance program. The Director of Billing Compliance will serve as the chair of the CHST Billing Compliance subcommittee, and will support other CHST Compliance governance committees and functions as necessary. The Director of Billing Compliance also acts as a channel of communication to receive and direct compliance issues to appropriate resources for investigation and resolution, and as a final internal resource with which concerned individuals may communicate after other formal problem resolution channels have been exhausted. The Director of Billing Compliance contributes to the success of Children’s mission and programs by minimizing its billing compliance risks and vulnerability to violations of complex state and federal laws and regulations, and the negative impact to its mission and community standing that would result from billing compliance violations.

WORK EXPERIENCE

• At least 10 years’ Experience in healthcare / hospital setting, preferably to include pediatric and/or academic medical center experience required.
• At least 5 years’ Experience in hospital and/or professional medical practice group billing, revenue cycle, HIM, or coding preferred.
• At least 2 years Direct role experience in compliance and/or billing/revenue cycle compliance required.

EDUCATION

• Four-year bachelor’s degree or equivalent experience required.
• Graduate or professional work or advanced degree; or equivalent experience preferred.

• Responds to alleged violations of Children’s Code of Conduct, policies or procedures and / or state and federal laws, rules, regulations by conducting necessary audits and investigations or by referring and collaborating with other departments (e.g., Revenue Cycle, Information Technology, Clinical Informatics, Human Resources, etc.) to direct issues to appropriate existing channels for investigation and resolution. Consults with internal and external counsel as needed to resolve related billing compliance-legal issues. Develops and oversees a system for uniform handling of potential billing compliance concerns.
• Designs and develops risk-based technical and professional billing compliance auditing program. Develops proficiency assessment, measurement systems, and schedules for re-audit based on individual performance assessments; directs performance of audits for professional and technical billing based on the risk-based criteria and performance as measured in baseline assessment; and, with the Billing Compliance Subcommittee, and other CHST governance groups, establishes an annual billing compliance workplan to further enhance the overall program.
• Oversees the design, development, and provision of education programs to support billing compliance requirements, including clinical documentation and coding standards, teaching supervision and related documentation standards, billing system coding requirements for administrative and finance staff. Identifies topics for education focus based on audit findings. Directs development of and provision of education. Ensures documentation of education and training.
• Supervises Billing Compliance Program staff: hires, develops, coaches, evaluates personnel. Selects, implements and oversees support resources (e.g., MD Audit program, other systems interfaces and data reports).
• Investigates reported non-compliance relating to billing, resolves billing compliance consults in a timely basis, and directs/oversees special projects related to billing compliance program efforts as assigned.
• Monitors billing practices and serves as point person for external billing audit activity for program integrity, desk audit and other payor program audit activity involving CHST technical or professional services. Partners with the appropriate departments and subject matter experts to audit request and response activities to ensure that audits are appropriate managed and any denials are reviewed and appealed or responded to in a timely manner. Further manages and monitors this work for trends, opportunities for improvement and/or issue escalation where appropriate.
• 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. Liaison with state and federal agencies as well as compliance professional association also promotes Children’s Health leadership role in healthcare compliance.