Director, Revenue Cycle Billing And Coding Compliance

What You Will Do:

The Director of Billing and Coding Compliance oversees the billing and coding compliance program, which is integral to the University of Maryland Medical System (UMMS) 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.

Principal Responsibilities and Tasks

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

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  Under the direction of the Vice President of Compliance Operations, collaborates with other departments to investigate and resolve reported compliance concerns related to coding & billing compliance.
• Communicates to the Vice President of Compliance Operations on any matter that potentially requires external reporting or is deemed potentially illegal, unethical, or otherwise inappropriate.
• Assists clinical services, revenue cycle management, and hospital leaders in conducting compliance risk assessments of the billing, coding, operations, and the implementation of annual work plans to ensure that identified risks are appropriately mitigated.
• Facilitates, promotes, and supports the 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 UMMS 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.
• 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.
• Provides or arranges for training of employees and clinical staff in the use of coding guidelines, practices, and proper documentation standards.
• Maintains awareness of federal, state, and local coding and billing compliance issues to monitor their relevance to the UMMS Corporate Compliance program. Interacts with government regulators and other agency representatives.
• Consults with internal counsel as needed to resolve difficult/legal compliance matters.
• Supervises and manages direct reports.
• Obtains up to date information on changes to rules, regulations, other agencies guidance and initiatives.
• Develop productivity benchmarks for coding and billing compliance staff.
• Implement performance improvement strategies to ensure performance metrics for accountability are consistently met.
• Responsible for organizing and managing the daily operations including workflow, staffing, data management and reporting. Develop systems and processes to organize daily review, investigation and closing of cases.
• Perform other duties as assigned.

What You Need to Be Successful:

Education and Experience

• Bachelor’s degree in related field is required.
• A minimum of 7 years of relevant experience in health care coding, billing and third-party reimbursement required.
• A minimum of 3 year of management experience required.
• 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.
• Current knowledge of accreditation standards, healthcare regulations, and healthcare policy.
• 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.

We are an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.