BaylorScott & White Health
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Director Billing Regulatory Compliance
at BaylorScott & White Health
The Directorof Billing and Regulatory Compliance directs the Baylor Scott and White (BSWH) facility billing compliance audit, compliance investigative, regulatory research effortsand also directs the employed physician coding audit function for both HealthTexas Provider Network (HTPN) and The Scott and White Clinic physician codingaudit function. This position manages a staff of 21 and reports to the VicePresident of Corporate Compliance.
WHAT IS EXPECTED (EssentialFunctions):
- Identifies and evaluates emergingcompliance risks, utilizing regulatory guidance, resources, and data analyticson an ongoing basis to implement leading billing compliance practices.
- Plans and directs CorporateCompliance audits to assess compliance with system policies/procedures andregulatory requirements; prepares and communicates audit findings, conclusions,and recommendations.
- Leads or directs bothgovernmental and sensitive investigations through with guidance from the BSWHLegal Department as appropriate.
- Routinely performs regulatoryresearch and provides written guidance to business partners on regulatorychanges, or request for interpretive guidance on billing or regulatoryconcerns.
- Directs the physician codingaudit departments for HTPN and S&W Clinic in a manner to mitigate physiciancoding anomalies for employed physicians.
- Establishcollaborative partnerships with key members of management to evaluate andaddress compliance issues on an ongoing basis, and develops and leadscompletion of annual work plans.
- Develop and maintain amultidisciplinary team to evaluate CMS and governmental document requests,audits, and denials to evaluate for systemic concerns or necessary processchanges.
- Tracks the resolution ofcorrective actions agreed to by management in response to both
- Corporate Compliance audits orinvestigations, or physician coding audits and provides summary reports ofactivity.
- Defines departmental goals andobjectives providing leadership and guidance in selection, training,motivation, and professional development of subordinate complianceprofessionals, and performs department managerial functions. The director alsoperforms other duties as assigned.
- Performs other positionappropriate duties as required in a competent, professional and courteousmanner.
KNOWLEDGE, SKILLS, and ABILITIES:
- Knowledge of Medicare/Medicaid hospital billing requirements/regulations
- Ability toresearch federal and state regulations and provide written guidance. Ability todirect compliance audits and investigations.
- Knowledge of Medicare CostReporting principles.
- Knowledge ofMicrosoft products to include Word, Excel, and Power Point. Epic Systemknowledge helpful.
- 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
6 plus years years experience