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Children's Hospital Boston Billing Compliance Auditor III in Boston, Massachusetts

73712BRJob Posting Title:Billing Compliance Auditor IIIDepartment:Medicine-Dept of MedicineAutoReqId:73712BRStatus:Full-TimeStandard Hours per Week:40 Job Posting Category:FinanceJob Posting Description:The Boston Children’s Hospital Billing Compliance Department is a dynamic team of certified coders, nurses and a data analyst whose primary responsibility is to identify and mitigate billing risk for the Hospital and the BCH Physicians’ Organization. Through monitoring and auditing, training and educating, and working with clinicians on billing initiatives, we work side by side with our best in class health care providers to ensure the services we bill to Federal, State and commercial payers comply with the defined requirements for billing.

The Professional Billing Compliance Auditor III will be responsible to:

  • Follow established protocols selects and reviews a percentage of records to assess coding documentation, billing and/or reimbursement practices for professional billing documentation compliance with all regulations of federal and state agencies and third party payers and hospital policy.

  • Maintain and review data and provides feedback to clinicians on audit scores. Assign performance scores and risk rating based on audit results.

  • In conjunction with appropriate personnel, investigate, evaluate and identify opportunities for improvement and recognizes their relative significance in the overall system and provide guidance to departments regarding internal controls.

  • Develop and maintain professional skills and knowledge through attendance at relevant conferences, seminars and other educational programs, participation in professional organizations and review of current literature.

  • Contribute to the teamwork within and between departments and organizations that support hospital operations.

  • Provide positive and effective customer service that supports departmental and hospital operations.

To qualify, you must have:

  • High School Diploma/GED is required; An Associates or Bachelor’s degree is preferred in Health Information Management or Nursing

  • 3 years of CPT and ICD10 coding experience; including some experience reviewing physician documentation and assisting physicians to meet CPT and ICD10 coding requirements is required

  • Professional Billing Coding certification (CPC, CCS-P) required

  • The 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.

  • Excellent communication skills in order to effectively deal with conflicting views or issues and mediate fair solutions, and well‑developed writing skills.

  • Hybrid/Remote. Potential 1x a week at office location, One Brookline Place.

Boston Children’s Hospital offers competitive compensation and unmatched benefits including flexible schedules, affordable health, vision and dental insurance, child care and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and certain License and Certification Reimbursement, cell phone plan discounts and discounted rates on T-passes. Experience the benefits of passion and teamwork.

Office/Site Location:BostonRegular, Temporary, Per Diem:Regular Remote Eligibility :Part Remote/Hybrid