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Dana-Farber Cancer Institute · 12 hours ago

Senior Billing Compliance Reviewer

Brookline, MA

Full-time

Onsite

Mid, Senior Level

$95K/yr - $106K/yr

5+ years exp

Dana-Farber Cancer Institute is a leader in life changing breakthroughs in cancer research and patient care. The Senior Billing Compliance Reviewer will oversee billing compliance activities, manage audits, and ensure adherence to federal and state regulations while collaborating with various departments.

CommunitiesHealth CareHealth DiagnosticsHospitalNon ProfitOncology

Responsibilities

Assist in creation and manage execution of annual Billing Compliance work plan for services including focused audits as they arise. Audits to be performed each year are identified based on the then-current Office of the Inspector General work plan and internal and external compliance risk analysis

Process paybacks including report generation, check requests, cover letters and supporting documentation as required for delivery to Chief Compliance Officer for final submission to payer

Review government and commercial payer policy updates (i.e., MCR NCD/LCD), regulatory, legal and industry developments for their applicability to the operation, determine risks and participate in the dissemination of relevant information

Manage audit software functions by setting criteria for routine and focused professional and technical audits including tracking tools and reports generation. Interface with audit software Help Desk and other staff to troubleshoot issues and implement software program changes

Utilize audit software reports, manage external hospital audits, including 60-day response cycle for government audits and conduct education as necessary or needed

Coordinate, assist and/or conduct billing compliance investigations as required, which may include audits designed to review the adequacy of medical record documentation to support claims as well as inquiries into suspected or reported deviation from billing compliance program requirements

Design and complete quarterly reporting metrics

Assist in the development of new billing compliance guidelines, procedures and training programs designed to enhance the effectiveness of billing compliance program, including participation of personal development activities

Attend and actively participate in various meetings which may include CPT-Epic, New Services, Regional Campuses, Inpatient Billing, ADCC and AAMC as well as other continuous quality improvement processes and workgroups as needed

Serve as a liaison and collaborate with business partners (revenue cycle, nursing, clinical operations, HIS, ancillary departments, etc.)

Work with the educator to enhance existing training programs, documentation tools and tip sheets

Special projects as assigned

Qualification

Billing ComplianceAudit SoftwareHealthcare CodingRegulatory KnowledgeCPC CertificationInterpersonal SkillsCommunication SkillsMultitaskingMicrosoft ApplicationsAttention to DetailTeam Player

Required

High school diploma required

5 years of experience in healthcare coding including at least 1 year of prior auditing experience

Knowledge of CMS (Medicare and Medicaid) and commercial payers billing and documentation guidelines, current coding resources, including CPT4, ICD-10-CM/PCS, HCPCS required

Certified Coder required (CPC, CCS, RHIT, or RHIA)

Strong interpersonal skills, including ability to establish and maintain effective relationships with providers, leadership, senior administration, colleagues, and billing compliance staff

Excellent written and verbal communications, facilitation, and presentation skills used to share audit findings, risk areas and billing compliance issues identified

Ability to work independently with limited supervision and willingness to be flexible depending on department needs

Ability to balance and manage multiple priorities and flexibility to reprioritize tasks when needed

Knowledge of various audit software, Epic and/or other comparable software and database tools

Knowledge of hospital operations, reimbursement, and applicable regulatory requirements

Ability to present findings and discuss issues with providers and other staff confidentially and effectively

Strong attention to detail and highly organized

Strong team player with ability to work well independently and as a group

Ability to work under pressure, multitask and meet deadlines

Technical capability to utilize multiple information systems and Microsoft applications