About this role
About the Role The Director Billing Compliance is a strategic leader and subject matter expert responsible for ensuring the integrity, accuracy, and compliance of billing practices across the organization. Reports to the VP, Chief Compliance Officer with a dotted line to the VP, Revenue Performance Management. 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. Serves as a key second line of defense in support of accurate and compliant operational processes. Works as a cross-functional leader, partnering with clinical, administrative, and financial teams and participating in committees and projects to set standards and ensure best practices are followed across the organization.
What You'll Do
- Design and implement comprehensive billing compliance programs, including goals and objectives.
- Monitor changes in healthcare regulations and updates compliance strategies accordingly; conduct routine monitoring, assess risk, lead investigations, respond to audits, provide guidance, and share findings with providers and leadership.
- Develop curriculum and deliver clinical documentation, coding and billing education for physicians, APPs, infusion nurses; ensure regulatory updates are understood and applied.
- Identify potential compliance risks and develop mitigation strategies; investigate non-compliance and implement corrective action plans; collaborate with legal and risk management.
- Maintain documentation of compliance activities; prepare reports for regulatory bodies and senior management.
- Collaborate with clinical, administrative, and financial teams across the Enterprise to integrate and align messaging; supervise staff, hire and develop team members, set expectations, and evaluate performance.
What We're Looking For
- Experience leading healthcare billing/compliance programs and teams.
- Knowledge of hospital and professional fee billing, and payer regulatory requirements.
- Ability to design, implement, monitor, audit, and improve billing compliance processes.
- Experience conducting investigations, audits, and developing corrective actions.
- Strong communication, collaboration, and cross-functional leadership skills; ability to partner with senior management and external partners.
Compensation & Benefits
- Salary: $154,200.00 - $170,800.00 per year.
- Location: Boston-area with remote/hybrid work options (remote with occasional onsite).