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Senior Compliance Auditor Job in Woburn, Massachusetts

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Job Title: Senior Compliance Auditor

Employer:Beth Israel Deaconess Medical Center
Required Certifications:CPC or CCS
Required Experience:5 to 7 years
Location: Woburn 01801, MA, US
Date Posted:5/24/2021

Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center, known as “HMFP” is an academic faculty practice that is the employed physician group of BIDMC. HMFP has an exclusive affiliation agreement with BIDMC for patient care, research and teaching services. We employ over 1,900 providers. Each of our 13 departments is led by a Chief of Service who collaborates with a Chief Administrative Officer. Our HMFP Corporate offices are based at BIDMC and in Woburn and provide comprehensive management services, including compliance, legal, finance, and human resources, to the departments and our employees.
Associated Physicians of Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center, Inc. or “APHMFP”) was formed in 2006 in support of the ongoing professional staffing needs in surrounding communities including our affiliates, BID Needham, BID Milton, and BID Plymouth, as well as partnerships with Anna Jaques Hospital, Cambridge Health Alliance, Harrington Hospital, Lawrence General Hospital, MetroWest Medical Center, Mount Auburn Hospital, Signature Healthcare, St. Luke’s Hospital, and St. Vincent’s Hospital. These affiliate relationships allow for expanded health care at the community level and close to patients’ homes.

Department Description: The Senior Compliance Auditor will be working with the HMFP Compliance Department.

Job Location: Woburn, MA

Req ID: 38465BR

Job Summary: The Senior Compliance Auditor will act as a lead role by providing resources, assistance and E/M experience to the audit team. The Senior Auditor will delegate tasks and set deadlines, monitor team performance and provide education according to training needs while supporting the Audit Manager by communicating concerns and identifying areas for improvement. Audits medical record documentation to determine if the documentation sufficiently supports the level of care billed for those services rendered according to Medicare, other federal insurance programs and third-party regulations. Provides guidance, training and education when applicable to HMFP Departments throughout the Institution. Collaborates with contract management specialist - BILPN, billing companies and other needed entities/third party payers to identify and analyze billing guidelines that may impact the overall compliance of the HMFP physicians' revenue cycle particularly those related to coding issues. Interacts closely with Technical Analysts to review and audit workfile use and make determinations based on CCI edits and other payer regulations that affect the day-to-day billing processes. Communicates to providers, department administration and billing companies along with suggested corrective action plans and additional training as needed. Interacts extensively with medical staff and other Medical Center personnel.

Essential Responsibilities:
  1. Acts as a lead role by providing resources, assistance and E/M experience to the audit team.
  2. Delegates tasks and set deadlines, monitor team performance and provide education according to training needs while supporting the Audit Manager by communicating concerns and identifying areas for improvement.
  3. Utilizing knowledge of ICD-10 and CPT-4 coding and guidelines for documentation of billings for physicians within the Harvard Medical Faculty Practice (HMFP) on a routine basis, ensures physicians are in compliance with Medicare, other federal insurance programs and third party regulations.
  4. Provides education and training for the Advanced Practice Practitioner compliance/billing and credentialing process to HMFP.
  5. Identifies any charges that need to be corrected for erroneous billing.
  6. Utilizes billing reports and systems available to identify high-risk areas for auditing.
  7. Performs special audits on the 'targeted areas' billing as published by the Office of the Inspector General (OIG.)
  8. Reports all findings of audits and informs the Compliance Manager and Officer of all discrepancies between billing and documentation; identifies physicians who are non-compliant.
  9. Provides training for non-compliant physicians on documentation guidelines. Monitors these physicians within three months by auditing their records to verify that they have assimilated the billing and documentation guidelines.
  10. Performs reimbursement-related activities as they relate to the HMFP reimbursement and revenue cycle.
Required Qualifications:
  1. High School diploma or GED required. Associate's degree in Business or Healthcare field preferred.
  2. Certificate 1 Certified Professional Coder required., or Certificate 2 CCS Physician-based required.
  3. 5-8 years related work experience required.
  4. Strong knowledge of reimbursement regulations, coding guidelines and compliance policies.
  5. Current knowledge of ICD-10 and CPT-4 Coding, medical terminology, Medicare, other federal insurance programs and third-party billing, and compliance regulations and guidelines.
  6. Self-motivated, ability to work independently and good interpersonal skills; must possess integrity.
  7. Experience with computer systems required, including web-based applications and some Microsoft Office applications which may include Outlook, Word, Excel, PowerPoint or Access.
Preferred Qualifications:
  1. Multi-specialty billing experience.
  1. Decision Making: Ability to make decisions that are guided by general instructions and practices requiring some interpretation. May make recommendations for solving problems of moderate complexity and importance.
  2. Problem Solving: Ability to address problems that are highly varied, complex and often non-recurring, requiring staff input, innovative, creative, and Lean diagnostic techniques to resolve issues.
  3. Independence of Action: Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seeks assistance when confronted with difficult and/or unpredictable situations. Work progress is monitored by supervisor/manager.
  4. Written Communications: Ability to communicate clearly and effectively in written English with internal and external customers.
  5. Oral Communications: Ability to comprehend and converse in English to communicate effectively with medical center staff, patients, families and external customers.
  6. Knowledge: Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations.
  7. Team Work: Ability to act as a team leader for small projects or workgroups, 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 to patients, visitors, staff and external customers in a professional, service-oriented, respectful manner using skills in active listening and problem solving. Ability to remain calm in stressful situations.

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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