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Compliance Coding Specialist Job in Boston, Massachusetts

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Job Title: Compliance Coding Specialist

Employer:Beth Israel Deaconess Medical Center
Required Certifications:CPC
Required Experience:8 to 10 years
Location:330 Brookline Ave Boston 02215, MA, US
Date Posted:6/15/2018
Department Description: The Compliance Coding Specialist role will be supporting the Harvard Medical Faculty Physicians (HMFP) Audit Team.

Job Location: Boston, MA

Req ID: 23835BR

Job Summary: The Compliance Coding Specialist performs multiple types of audits and reviews on clinical documentation. The review/audit includes trending information, data analysis and written reports. This position will also review the documentation for accuracy of the ICD-10-CM codes, CPT and HCPCS codes in detail to support the overall audit program's objectives and education needs for the physician group.

Essential Responsibilities: 
  1. Applies knowledge of ICD-10 and CPT-4 coding and guidelines for documentation and billings to perform audits on physicians within the Harvard Medical Faculty Practice (HMFP) to ensure that documentation is in compliance with Medicare, other federal insurance programs and third party regulations.
  2. Develops and delivers training materials to educate physicians and staff on billing and documentation regulatory requirements.
  3. Identifies charges that need to be corrected for erroneous billing. Tracks coding issues by provider and provides necessary education to providers and other department staff to improve coding. Monitors and audits records to verify that billing and documentation guidelines are being applied accurately.
  4. Utilizes billing reports and systems to identify high-risk areas for auditing. Focuses special audits on the targeted areas of billing as published by the Office of the Inspector General (OIG.) Prepares reports and presents findings to management. Identifies discrepancies between billing, documentation and coding and the physicians or coders who are non-compliant.
  5. Disseminates new codes to all HMFP departments. Participates in coding review activities that require compliance oversight such as E-ticket, Visit Ticket and TES/Medicode committees. Manages special projects and represents the department on committees as assigned.
Required Qualifications:
  1. Bachelor's degree required.
  2. Certificate 1 Certified Professional Coder required.
  3. 8-10 years related work experience required.
  4. Certification from AAPC or AHIMA for professional coding.
  5. Knowledge CMS (Medicare and Medicaid and other third party payers billing and documentation requirements.
  6. Knowledge of physician billing with American Academy of Professional Coders (AAPC) and / or American Health Information Certificate (CCS / CCS -P)
  7. Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis and maintain databases.
  1. Decision Making: Ability to make decisions that are guided by precedents, policies and objectives. Regularly makes decisions and recommendations on issues affecting a department or functional area.
  2. Problem Solving: Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge and skills based on general precedents.
  3. Independence of Action: Ability to set goals and determines how to accomplish defined results with some guidelines. Manager/Director provides broad guidance and overall direction.
  4. Written Communications: Ability to summarize and communicate in English moderately complex information in varied written formats to internal and external customers.
  5. Oral Communications: Ability to comprehend and communicate complex verbal information in English to medical center staff, patients, families and external customers.
  6. Knowledge: Ability to demonstrate in-depth knowledge of concepts, practices and policies with the ability to use them in complex varied situations.
  7. Team Work: Ability to act as a team leader for small projects or work groups, creating a collaborative and respectful team environment and improving workflows. Results may impact the operations of one or more departments.
  8. Customer Service: Ability to provide a high level of customer service and staff training to meet customer service standards and expectations for the assigned unit(s). Resolves service issues in the assigned unit(s) in a timely and respectful manner.

Physical Nature of the Job:
Sedentary work: Exerting up to 10 pounds of force occasionally in carrying, lifting, pushing, pulling objects. Sitting most of the time, with walking and standing required only occasionally.



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