Director, Billing Compliance - ESRD (Remote)

Job Description

The Director, Billing Compliance – ESRD (End Stage Renal Disease) is responsible for Compliance within assigned functions, which may include one or more business function and/or clinical franchise(s).  Compliance support for senior leadership of the assigned function(s) to ensure compliance and find solutions to complex compliance issues. 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), as applicable. Engaged in all aspects of the business and seen as a key driver of requirements in complex situations.

This is a remote-based assignment.

Responsibilities:

• Drive the Quest Diagnostics compliance program by leading projects and overseeing identification and resolution of complex compliance issues related to all assigned functions.

• Function as primary Compliance support to assigned function(s) which may include one or more of the following: Chronic Kidney Disease,subsidiary businesses, corporate functions and/or one or more of the Clinical Franchise(s) and in one (1) or multiple regions.

• Provide guidance to business and billing organization related to billing practices unique to subsidiary, corporate function or franchise and drive compliance. 

• Ensure compliant outcomes for all systems and customer and product offering conversions, including laboratory and billing system implementations/conversions. 

• Actively participate in and manage the compliance audit process related to assigned functions with a goal of green audits. As applicable coordinate action plans within the assigned functions to drive complete resolution of audit issues on a timely basis. 

• Drive compliance with federal and state fraud and abuse and related laws for the assigned functions.

• Proactively enhance compliance in assigned functions. 

• Engage actively with the leadership team of assigned function(s) in key business initiatives to identify and address any compliance issues and to develop compliant solutions.

• Support due diligence activities as needed.

• Help develop and deliver Compliance/ Privacy related training for the supported areas.

• Partner with Legal and other functions, including Government Affairs, to ensure that the businesses are aware of and in compliance with federal and state laws and billing requirements for government and commercial payers.

• Provide feedback in the development and execution of corporate Compliance initiatives.

• Initiate and lead special projects as needed to monitor compliance in designated areas.

• Perform other compliance related tasks and projects as assigned.

• Develop and effectively communicate complex concepts using verbal and written methods.

Qualifications:

• ABachelor’sdegree in a Science, Business, or related field isrequired.AMaster’sdegreeispreferred.

• MT (ASCP) and CPC certification preferred.

• At least 7 years of compliance experience or related experience, with 3 years of experience in ESRD billing and healthcare. 

• At least 3 years of healthcare compliance experience.

• Experience in the clinical laboratory industry preferred. 

• Ability to evaluate business proposals and identify potential legal, regulatory and compliance concerns.

• Experience in dialysis billing, including Medicare ESRD PPS and payer-specific composite rate payment, methodologies is required.

• Experience in the healthcare environment doing business with Medicare and Medicaid as a clinical laboratory, or similar third-party payer relationship.

• Ability to adjust priorities and focus quickly as circumstances dictate. 

• Ability to interact professionally with colleagues and/or customers for different purposes in different contexts; including medical colleagues regarding complex testing/concepts.

• Effective verbal and written communication, including presentation skills, at a level appropriate for communication with director-level colleagues and customers. 

• Ability to professionally interact with outside agencies.

• Ability to communicate complex issues clearly and concisely to internal and external constituencies.

• Approximately 10-20% travel will be required.

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