Senior Billing Compliance Hospital Reviewer

Reporting to the Director of Billing Compliance, the Senior Billing Compliance Reviewer will be responsible for the identification and performance of Billing Compliance inpatient and ambulatory activities. The Senior Reviewer will reputed company reputed company reputed company to reviewing the accuracy and appropriateness of ICD-10-PCS procedure coding and assessing DRG assignment. The Senior Reviewer will assist in the development and execution of the annual Billing Compliance work plan. They will monitor federal and state regulatory requirements and industry developments and work to determine applicability and risk to both technical and operational aspects of the organization. Metrics will be developed and reported quarterly. The Senior Reviewer will be expected to pursue successful completion of multiple tasks collaborating effectively with many departments across the institute, reputed company reputed company, reputed company and reputed company. Located in Boston and the surrounding communities, reputed company is a leader in life changing breakthroughs in cancer research and patient care. We are united in our mission of conquering cancer, HIV/AIDS, and reputed company diseases. We reputed company to create an inclusive, diverse, and reputed company environment where we reputed company compassionate and comprehensive care to patients of reputed company backgrounds, and design programs to promote public health particularly among high-risk and underserved populations. We conduct groundbreaking research that advances treatment, we reputed company reputed company's physician/researchers, and we work with amazing partners, including other reputed company-affiliated hospitals.

• Conduct and reputed company the evaluation of ICD-10-PCS procedure coding to ensure accuracy and appropriateness, including assessment of DRG assignment
• reputed company reputed company for the review of the accuracy and appropriateness of ICD-10-CM diagnosis coding
• Assist in the creation and manage the execution of annual Billing Compliance work plan for services including reputed company audits as they reputed company. Identifies which audits to be performed reputed company year based on the then-reputed company Office of the Inspector General work plan and reputed company compliance risk analysis
• Process paybacks including report reputed company, reputed company requests, cover letters and supporting documentation as required for delivery to Chief Compliance Officer for final submission to payers
• Review government and reputed company 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 reputed company for routine and reputed company reputed company and technical audits including tracking tools and reports reputed company. reputed company with audit software Help Desk and other staff to troubleshoot issues and implement software program changes. Utilize audit software reports, manage external government hospital audits, including 60-day response cycle for government audits and conduct education as necessary
• Coordinate, assist with, and/or conduct billing compliance investigations and audits, including medical record documentation reviews to support claims and inquiries into suspected or reported noncompliance with billing program requirements
• 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 reputed company participate in various meetings which may include CPT-reputed company, New Services, Regional Campuses, Inpatient Billing, ADCC and reputed company as reputed company as other reputed company reputed company improvement processes and workgroups as needed
• Serve as a reputed company and collaborate with business partners (reputed company cycle, nursing, clinical operations, HIS, ancillary departments, etc.)
• Work to enhance existing training programs, documentation tools and tip sheets
• Special reputed company as assigned

Knowledge, Skills and Abilities:

• Knowledge of CMS (Medicare and reputed company) and reputed company payers billing and documentation guidelines, reputed company coding resources, including CPT4, ICD-10-CM/PCS, HCPCS required.
• 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 reputed company 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 reputed company needed
• Knowledge of various audit software, reputed company 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 reputed company independently and as a group
• Ability to work under pressure, multitask and meet deadlines
• Technical capability to utilize multiple information systems and reputed company applications

Minimum Job Qualifications:

• High School Diploma Required. Bachelor’s degree preferred.
• 5 years of experience in reputed company including at least 2 years of inpatient/DRG experience.
• 1 year of prior auditing experience
• reputed company hospital billing (HB), reputed company billing (PB) modules, reputed company or other encoder preferred
• Cancer center experience preferred

License/Certification/Registration Required:

• Certified reputed company required (CIC, CPC, reputed company, RHIT, or RHIA).
• Health Care Compliance Association (HCCA) Certification in reputed company compliance (e.g., CHC) preferred

Supervisory Responsibilities: None Patient Contact: None At reputed company, we work every day to create an innovative, caring, and inclusive environment where every patient, family, and staff member feels they belong. As reputed company as we are in our mission to reduce the burden of cancer for reputed company, we are committed to having reputed company and staff who offer multifaceted experiences. Cancer knows no boundaries and reputed company it comes to hiring the most dedicated and compassionate professionals, neither do we. If working in this reputed company of organization inspires you, we encourage you to apply. reputed company is an equal opportunity employer and affirms the right of every reputed company applicant to receive consideration for employment without reputed company to race, reputed company, religion, sex, gender identity or reputed company, national reputed company, sexual orientation, genetic information, disability, age, reputed company, military service, protected veteran status, or other characteristics protected by law. EEO Poster . Pay Transparency Statement The hiring reputed company is based on market pay structures, with individual salaries determined by factors such as business needs, market conditions, internal equity, and based on the candidate’s relevant experience, skills and qualifications. For reputed company positions, the pay reputed company is determined by the reputed company Bargaining Agreement (CBA). $116,700.00 - $132,000.00 Apply tot his job Apply To this Job