• Director, Insurance Billing Compliance

    Job ID
    2018-23264
    Employment Type
    full-time
    Hours Per Week
    40
    Onsite Work Schedule Details
    M-F 8:00-5:00
  • Overview

    The Director, Billing Compliance will ensure adhering to all federal and state guidelines as relates to billing services.  Monitoring edits/bridge routine requests to ensure meeting guidelines appropriately and compliantly billing claims to all third party payors.

    Responsibilities

    • Maintains written documentation for billing guidelines for Medicare and Medicaid for clients.
    • Ensures any new edits/bridge routines are compliant for billing.
    • Monitors any changes to regulations for federal and State guidelines and escalates to VP and Sr. Director, ARS for Billing.
    • Conducts internal audits on claims (by client) to ensure meeting federal guidelines – makes recommendations of changes as items are found.
    • Conducts regular audits and coordinates ongoing monitoring of billing accuracy and documentation to ensure compliant billing.
    • Ensures the appropriate dissemination and communication of all regulation, policy and guideline changes to affected personnel.
    • Leads Billing Governance committee and collaborates with Operations and Support organizations.
    • Assesses product, compliance, or operational risks and develops risk management strategies.
    • Serves as a confidential point of contact for employees to communicate with management, seek clarification on issues or dilemmas, or report irregularities.
    • Maintains documentation of compliance activities, such as complaints received or investigation outcomes.

    Qualifications

    • High school diploma or GED.
    • At least 5 years of experience as a Manager or Director of acute care hospital billing, working with government, commercial and patient liability accounts.
    • At least 5 years of experience as a Manager or Director of either acute care hospital or physician office collections, working with government, commercial and patient liability accounts.
    • Builds high performing teams and attains personal and team goals.
    • Has the ability to represent the revenue cycle within the organization. 
    • General understanding of coding guidelines.
    • Excellent written/verbal communication skills
    • Capable of critical thinking and exhibits advanced analytical skills.
    • Manages financial resources effectively.
    • Solid knowledge of all MS Office Products as well as Collections Workflow tools.
    • Minimal travel required.

    Preferred Skills

    • Bachelor’s degree.
    • Acute care collections experience.

    About nThrive

    Be Inspired. Ignite Change. Transform Health Care.
    From Patient-to-Payment, nThrive provides all the technology, advisory expertise, services, analytics and education programs health care organizations need to thrive in the communities they serve. Our colleagues share a united passion to help health care organizations strengthen their financial position, which translates to accessible, quality care for all. This passion fuels our drive to innovate and participate in community outreach through the nThrive CARES program. Our colleagues are encouraged to think differently and empowered to make a lasting impact that ensures our health care providers, and our world, are healthy and productive.

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