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Dana-Farber Cancer Institute · 5 hours ago

Billing Compliance Reviewer

Brookline, MA

Full-time

Onsite

Mid Level

$84K/yr - $91K/yr

3+ years exp

Dana-Farber Cancer Institute is a leader in life changing breakthroughs in cancer research and patient care. The Billing Compliance Reviewer will be responsible for reviewing and analyzing coding and compliance activities related to reimbursement, ensuring regulatory requirements are met and providing education to providers on documentation and coding.

CommunitiesHealth CareHealth DiagnosticsHospitalNon ProfitOncology

Responsibilities

Manage auditing software functions by setting criteria for routine audits including tracking tools and report generation

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

Conduct post-audit education 1:1 with providers audited

Effectively monitor and create reports with detailed feedback for providers as well as clinical and administrative leadership

Work collaboratively with Coding, HIM and Billing team representatives to evaluate complex billing issues and initiate appropriate internal and external audit responses, including record retrieval, refunding, rebilling or appealing based on established guidelines

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

Serve as a liaison to business partners, third party payers and regulatory entities for clarification and interpretation of billing guidelines and documentation

Special projects as assigned

Qualification

Healthcare coding experienceCMS guidelinesCertified Coder CPCCertified Coder CCSCertified Coder RHITCertified Coder RHIAEpicAuditing software proficiencyAnalytical skillsMulti-tasking abilityMicrosoft applications proficiencyAttention to detailInterpersonal skillsPresentation skillsWritten communication skillsOral communication skillsTeam playerWork under pressure