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Billing Compliance Auditor I Job in Boston, Massachusetts

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Job Title: Billing Compliance Auditor I

Employer:Boston Children's Hospital
Job Location:Partial Remote
Required Certifications:CPC,CCS-P
Preferred Certifications:CPMA
Required Experience:1 to 2 years
Preferred Experience:1 to 2 years
Location: Boston 02215, MA, US
Date Posted:5/11/2021
At Boston Children’s Hospital, the quality of our care – and our inclusive hospital working environment – lies in the diversity of our people. With patients from local communities and 160 countries around the world, we’re committed to reflecting the spectrum of their cultures, while opening doors of opportunity for our team. Here, different talents pursue common goals. Voices are heard and ideas are shared. Join us, and discover how your unique contributions can change lives. Yours included.

This Billing Compliance Auditor for Neurology Foundation will be responsible for:
  • Following established protocols, selecting and reviewing a percentage of records to assess coding documentation, billing, and/or reimbursement practices for compliance with all regulations of federal and state agencies and third-party payors and hospital policy.
  • Maintaining review data and provides feedback to relevant areas in collaboration with appropriate personnel. Assigning performance scores and risk rating based on audit results.
  •  In conjunction with appropriate personnel, investigating, evaluating, and identifying opportunities for improvement and recognizes their relative significance in the overall system, and provides guidance to departments regarding internal controls. Developing and drafts billing and coding policies for the  Neurology Foundation in coordination with the Hospital.
  • Developing and maintaining professional skills and knowledge through attendance at relevant conferences, seminars, and other educational programs, participation in professional organizations, and review of current literature.
  • Contributing to the teamwork within and between departments and organizations that support hospital operations.
  • Providing positive and effective customer service that supports departmental and hospital operations.
  • Checking regular and Psychiatry work queues to resolve coding issues (CPT and ICD-10) and date of service issues.
  • Requesting reports for professional services as needed by management.
  • Weekly audit requests.
  • Patient problem/billing issues.
  • Overseeing credentialing of new providers, termination of providers and tracking of on-going re-creds with the credentialing department.

To qualify, you must have:
  • A Bachelor's degree in Health Information Management or Nursing.
  • Professional Billing Coding certification (CPC, CCS-P) CPMA certification would be preferred.
  • 1 year CPT and ICD10 coding experience; including some experience reviewing physician documentation and assisting physicians to meet CPT and ICD10 coding requirements.
  • Knowledge of healthcare compliance regulations is a plus.
  • Analytical skills to collect information from diverse sources, apply professional principles in performing various analyses, and summarize the information and data in order to solve problems OR design relatively complex systems and programs that cross-department/divisional lines.
  • Communication skills in order to effectively deal with conflicting views or issues and mediate fair solutions, and well-developed writing skills.

Please note: During a public health emergency, individuals in this role may be expected to take on additional duties to respond to organizational needs
Boston Children’s Hospital offers competitive compensation and unmatched benefits, including a flexible schedule, affordable health, vision and dental insurance, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition Reimbursement, and discounted rates on T-passes. Discover your best.

Boston Children’s Hospital is an Equal Opportunity / Affirmative Action Employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, sex, sexual orientation, gender identity, protected veteran status or disability.


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