Compliance Director, Billing and Investigations in Collegeville, PA at Quest Diagnostics

Date Posted: 6/11/2021

Job Snapshot

Job Description

Look for more than answers.

Patients and Physicians rely on our diagnostic testing, information and services to help them make better healthcare decisions. These are often serious decisions with far reaching consequences, and require sensitivity, tact and a clear dedication to service. It’s about providing clarity and hope.

As a Compliance Director, you will work for the world leader in the industry, with a career where you will have the opportunity to collaborate and affect change while expanding your leadership skills and technical knowledge. You can make a real impact in a market that is growing and developing.

Compliance Director, Billing and Investigations, the role:

The Compliance Director is responsible for Compliance within the assigned function, which may include Revenue Services, International, ExamOne and/or a specific Clinical Franchise(s). This professional will partner with senior leadership of the assigned function(s) to ensure compliance and find solutions to compliance issues, and is responsible for communicating and proactively driving and monitoring compliance with all applicable federal and state laws, regulations, policy directives, compliance policies and procedures and ethical requirements, directly and through supervision of Compliance personnel within the assigned function(s). The Compliance Director is also engaged in all aspects of the business and seen as a key driver of requirements in complex situations.

Duties and responsibilities:

  • The Compliance Director acts as primary Compliance support to the Revenue Services and other assigned function(s) which may include one or more of the following:  International, ExamOne and/or one or more of the Clinical Franchise(s).
  • Drives compliance with federal and state fraud and abuse and related laws by the Revenue Services function and other assigned functions.
  • Proactively enhances compliance in the Revenue Services and other assigned functions.
  • Manages the process by which the Company self-disclosure actual or potential violations of law to CMS and/or HHS/OIG through the provider Self disclosure Protocols, as directed by Legal counsel.
  • Acts as a member of the leadership team in the assigned function(s) and provide Compliance support to senior leadership including Franchise General Manager(s) and functional Executive Directors and Vice Presidents.
  • Engages actively with the senior leadership team of assigned function(s) in all key business initiatives to identify and address any compliance issues and to develop compliant solutions.
  • Drives the Quest Diagnostics compliance program by leading projects and overseeing the identification and resolution of corporate-wide complex compliance issues related to reimbursement and all other assigned functions.
  • Works with Legal and other functions including Government Affairs to ensure that the businesses are aware of and in compliance with all federal and state regulations.
  • Represents the Company at trade industry organization meetings and/or Medicare/Medicaid contractor meetings, as needed.
  • Manages the monthly excluded provider review of employees, contractors, vendors and clients for all lines of business. Outsources process to contracted vendors and manage vendor relationships on an ongoing basis.
  • Provides feedback in the development and execution of corporate Compliance initiatives.
  • Coordinates with other Functional Compliance Directors and SMEs in Corporate Compliance to obtain Compliance approval of initiatives where necessary and to ensure consistency across the Company.
  • Manages and supervises the activities of the Compliance personnel assigned to the function(s)
  • Initiates and leads special projects as needed to monitor compliance in designated areas.
  • Supervises compliance analysts.

To qualify, the ideal candidate will have the following skills and experience:

  • BS in Science Discipline, Business or related field, or equivalent
  • MS/MBA preferred
  • MT (ASCP) and CPC certification preferred
  • 5+ years people management experience
  • 8+ years in the healthcare environment doing business with Medicare and Medicaid as a clinical laboratory, or similar third party payer relationship.
  • 8+ years in the clinical laboratory
  • Experience with health care billing and coding practices, coding systems for medical services, health care delivery systems, and medical bill processing systems; 
  • Experience in fact finding, analysis, problem solving, and evaluating coding matters and other health care issues in order to make decisions
  • Demonstrated program management experience and ability to prioritize activities of others
  • Effective verbal and written communication, including presentation skills, at a level appropriate for communication with director-level colleagues and customers
  • Thorough knowledge of and application of all compliance policies and procedures, including the rationale and application to diverse situations and the impact of potential violations
  • Thorough understanding of all federal and state fraud and abuse laws and regulations or the ability to learn them
  • Thorough understanding of health care coverage, payment and administrative policy, and its business impact on billing, operations and financials
  • Ability to review and understand complex Medical information and how this information relates to Compliance
  • Thorough understanding of the esoteric laboratory business
  • Proven ability to negotiate and influence change
  • Experience working with the AMA for guidance requests and CPT coding applications
  • Demonstrated ability to manage multiple priorities/projects simultaneously
  • Complete projects while meeting goals within established time deadlines
  • Technical competency including Excel, Word, Outlook, Laboratory and Billing systems
  • Understanding of the technical aspects of laboratory testing

Apply Today

Join us for competitive benefits and development opportunities in a progressive and supportive environment. Help us improve our service, and the experiences of our patients and colleagues. Work with us and together we can be better.

Your Quest career. Seek it out.

All requirements are subject to possible modifications to reasonably accommodate individuals with disabilities. Quest Diagnostics is an Equal Opportunity Employer: Women / Minorities / Veterans / Disabled / Sexual Orientation / Gender Identity or Citizenship.