Director of Healthcare Compliance, Strategy and Medical Billing

Job Type

Full-time

Description

SCHEDULE: 40 hours, Monday-Friday, 8:30am-5:00pm

LOCATION: 444 Harrison Ave. Boston and other regional locations as needed. This position is eligible for hybrid work pursuant to PSI's Remote Work Policy

SUMMARY OF THIS POSITION:

This position is responsible for the healthcare strategy and compliance across the organization, which includes all Medicaid billable programs including the Stabilization Day Treatment Program, CSP, Recovery Coaching and any potential new programs under the direction of the COSE. The Director will monitor healthcare trends and will identify additional revenue sources through new and current contracting models.

The Director works closely with Pine Street Inn's finance department, creating and maintaining a collaborative environment for continual improvement in reporting, tracking and performance. They also are the primary relationship manager with external support teams and payors as well as all government committees and departments in the area of Healthcare Strategy. The Director is also responsible for implementation and strategy for all special healthcare initiatives such as CAC, redeterminations and mobile benefits enrollment.

This position is responsible for ensuring the compliance of agency policies related to HIPAA, 42 CFR Part 2, Privacy Practices, Medicaid Fraud and Billing and in addition, monitoring and informing senior leadership of the changes to state regulations and insurance contracts. This position provides consultation to the COSE, COP and Program and Operations teams in the area of Healthcare Strategy and Compliance.

The Director has the final responsibility to continuously analyze and improve the revenue performance and processes from start (enrollment) to finish, including user experiences, customer service and support.

Requirements

EDUCATION/TRAINING: REQUIRED:

• High School Diploma with extensive experience in Health Care Compliance and a combination on skills in regulatory affairs in Operations and IT ?
• Extensive knowledge regarding HIPAA, 42 CFR Part 2, Privacy Practices, Medicaid Fraud and Billing

PREFERRED:

• Master's degree in social work, Counseling Psychology, or related field or experience
• Certification in Qualify Control and Quality Standards
• Significant financial reporting capabilities ? Senior program management experience in a human services organization

KNOWLEDGE/EXPERIENCE: REQUIRED:

• A minimum of four (4) years of supervisory experience
• An extensive understanding of Managed Care Organizations, payor contracts and billing
• A working knowledge of Homeless Management Information Systems
• A minimum of two (2) years' experience as the system administrator/primary high-level administrator of an electronic health record system ? Knowledge of low income and homeless individuals
• Knowledge of 42 CFR, Confidentiality and HIPAA regulations PREFERRED:
• Training program development
• Able to build project plans and guide teams through to implementation. Set up consistent, applicable KPI's and monitoring systems.