Billing Compliance Auditor/Educator at Partner's Healthcare in Boston, Massachusetts

Job Description:

Site: The Brigham and Women's Hospital, Inc.


At Mass General Brigham, we know it takes a surprising range of talented professionals to advance our mission-from doctors, nurses, business people and tech experts, to dedicated researchers and systems analysts. As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community. We place great value on being a diverse, equitable and inclusive organization as we aim to reflect the diversity of the patients we serve.


At Mass General Brigham, we believe a diverse set of backgrounds and lived experiences makes us stronger by challenging our assumptions with new perspectives that can drive revolutionary discoveries in medical innovations in research and patient care. Therefore, we invite and welcome applicants from traditionally underrepresented groups in healthcare - people of color, people with disabilities, LGBTQ community, and/or gender expansive, first and second-generation immigrants, veterans, and people from different socioeconomic backgrounds - to apply.



Job Summary
Responsible to assess organization risk through the review of clinical documentation, billing claims data and revenue cycle workflows. Deliver feedback and education to clinical and revenue cycle departments through written and face to face communications, including individual and group training.


Essential Functions


Audit and analyze the documentation accuracy, medical necessity and billing code selection of clinical and billing providers in alignment with CMS, OIG and other applicable professional services regulations and guidelines.


Prepare audits, reports and educational content as necessary.


Effectively monitor and report detailed feedback to appropriate clinical and administrative providers.


Design and deliver provider training to clinical caregivers and administrative staff on the rules and regulations related to billing compliance and coding, including findings related to audits.


Assist in the development of new compliance guidelines, procedures, and training programs designed to enhance the effectiveness of the department.



Qualifications

• Associate's Degree Business Administration required. Bachelor's Degree Business Administration preferred


• 1-2 years required in billing, audit, medical records coding experience

Knowledge, Skills & Abilities

• Ability to problem solve and trouble shoot independently.


• Advanced understanding and use of medical terminology.


• Understand clinical workflows and concerns in a variety of healthcare business areas.


• Advanced comprehension of billing and fiscal information.


• Advanced computer skills.


• Strong attention to detail.

Additional Job Details (if applicable)



Physical Requirements



Standing Occasionally (3-33%) Walking Occasionally (3-33%) Sitting Constantly (67-100%) Lifting Occasionally (3-33%) 20lbs - 35lbs Carrying Occasionally (3-33%) 20lbs - 35lbs Pushing Rarely (Less than 2%) Pulling Rarely (Less than 2%) Climbing Rarely (Less than 2%) Balancing Occasionally (3-33%) Stooping Occasionally (3-33%) Kneeling Rarely (Less than 2%) Crouching Rarely (Less than 2%) Crawling Rarely (Less than 2%) Reaching Occasionally (3-33%) Gross Manipulation (Handling) Constantly (67-100%) Fine Manipulation (Fingering) Frequently (34-66%) Feeling Constantly (67-100%) Foot Use Rarely (Less than 2%) Vision - Far Constantly (67-100%) Vision - Near Constantly (67-100%) Talking Constantly (67-100%) Hearing Constantly (67-100%)



Remote Type


Remote



Work Location


801 Massachusetts Avenue



Scheduled Weekly Hours


40



Employee Type


Regular



Work Shift


Day (United States of America)



EEO Statement:


The Brigham and Women's Hospital, Inc. is an Affirmative Action Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.



Mass General Brigham Competency Framework


At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline. Apply Now