Job Description

At Pediatric Home Service, we help medically complex kids live their best lives, at home, with their families. As a national leader in pediatric home care, we offer a full range of services including infusion, clinical nutrition, respiratory therapy, PPEC, private duty nursing, and DME. Whether you're caring for patients or supporting behind the scenes, every role at PHS makes a difference. Join a mission-driven team that’s committed to putting children and families first.

• Position: Director of Billing Compliance
• Location: Roseville, MN
• Hours: Monday-Friday, 8am-5pm

POSITION DETAILS: The Director of Billing Compliance is responsible for leading and overseeing the organization’s billing compliance program and managing a team of compliance professionals. This role ensures adherence to federal, state, and payer regulations governing coding, documentation, billing, and reimbursement. The Director provides strategic oversight of audit functions, risk mitigation initiatives, and regulatory readiness while fostering a culture of integrity and accountability.

Job Duties

Leadership & Team Oversight

• Lead, mentor, and develop a team of Billing Compliance Supervisor, Coders, Specialists and Coordinators.
• Establish performance goals, conduct evaluations, and support professional development.
• Promote collaboration between Compliance, Revenue Cycle, Clinical Operations, and Finance.
• Allocate resources and prioritize work to ensure timely audits and issue resolution.

Compliance Program Management

• Design, implement, and continuously improve the billing compliance program.
• Ensure alignment with CMS, OIG, HIPAA, Medicare, Medicaid, and commercial payer requirements.
• Monitor regulatory updates and assess operational impact.
• Develop annual compliance work plans and risk-based audit strategies.

Audit & Monitoring

• Oversee internal and external billing audits, including coding validation and documentation reviews.
• Direct ongoing monitoring activities to detect potential overpayments, underpayments, or fraud risks.
• Review audit findings and ensure corrective action plans are implemented effectively.
• Track and report compliance metrics, trends, and risk exposure to executive leadership.

Regulatory & Risk Management

• Serve as primary contact for Medicaid and payer inquiries and external audits.
• Conduct enterprise-level billing risk assessments.
• Partner with Legal and Internal Audit on investigations and self-disclosures when necessary.
• Ensure timely reporting and repayment of identified overpayments in accordance with regulatory requirements.

Education & Policy Development

• Develop and deliver compliance training for coding, billing, and operational leaders.
• Maintain and update billing compliance policies and procedures.
• Provide subject matter expertise on new service lines, reimbursement models, and payer contracts.

Supervisory Responsibilities: Supervises assigned staff. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems

REQUIREMENTS

Education and/or Experience:

• Bachelor’s degree in Healthcare Administration, Business, Finance, or related field (Master’s degree preferred)
• 6-8 years of progressive experience in healthcare compliance, revenue cycle, or healthcare auditing
• Minimum 5 years in a leadership role overseeing compliance or billing operations
• Deep understanding of healthcare billing regulations, reimbursement methodologies, and fraud & abuse laws
• Expertise in Medicare, Medicaid, and commercial payer compliance
• Strong leadership and team development capabilities
• Advanced analytical and problem-solving skills
• Ability to communicate complex regulatory issues to executive stakeholders
• Experience with data analytics and audit reporting tools

Certificates (Preferred)

• Certified in Healthcare Compliance (CHC)
• Certified Professional Coder (CPC)
• Certified Professional Compliance Officer (CPCO)
• Certified Internal Auditor (CIA)

BENEFITS

• Generous Paid Time Off (PTO) for full time employees to ensure a healthy work-life balance
• 401(k) Matching to help secure your future
• Tuition Reimbursement to support your educational and professional growth
• Professional Development & Learning Opportunities to expand your skills and knowledge in pediatric care
• Health and Dental insurance
• Short & Long Term Disability and Life Insurance

SALARY RANGE:

At PHS, we are committed to providing specialized care for medically complex children. Every role, from direct patient care to customer support, plays a vital part in improving the lives of kids and families. The impact you make is invaluable. We are dedicated to offering fair and transparent compensation to our team members. The starting rate for this role is $128,807 annually, based on experience and qualifications.

Interested candidates should apply online at http://www.phscareers.com

We look forward to learning more about you & the skills you can bring to Pediatric Home Service!

Pediatric Home Service is an equal opportunity employer; we are committed to affirmative action and equal employment opportunities for all regardless of protected veteran status, race, color, creed, religion, national origin, sex, sexual orientation or identity, disability, age, marital status, familial status, membership or activity in a local human rights commission, or status with regard to public assistance.