Billing Compliance Reviewer, (AAPC, or AHIMA)

Dana-Farber Cancer Institute
Published
August 4, 2019
Location
Boston, MA
Job Type

Description

Located in Boston and the surrounding communities, Dana-Farber Cancer Institute brings together world renowned clinicians, innovative researchers and dedicated professionals, allies in the common mission of conquering cancer, HIV/AIDS and related diseases. Combining extremely talented people with the best technologies in a genuinely positive environment, we provide compassionate and comprehensive care to patients of all ages; we conduct research that advances treatment; we educate tomorrow's physician/researchers; we reach out to underserved members of our community; and we work with amazing partners, including other Harvard Medical School-affiliated hospitals.

Reporting to the Director of Billing Compliance the Billing Compliance Reviewer will be responsible for review and analysis of coding and billing compliance activities directly related to reimbursement for professional and institutional services to ensure Federal and State regulatory requirements are met and the program aligns with industry standards. The incumbent will perform audits of clinicians and other documentation to ensure that documentation supports the service that was performed and billed. The incumbent will be responsible for educating the clinicians on coding, and billing compliance issues and tracking completion of billing compliance training.

Responsibilities

Manage audit software products by setting criteria for quarterly, semi-annual, annual and biennial audits including tracking tools and reports generation. Interface with vendors support staff to troubleshoot issues and implement software program changes as needed
Audit and analyze the documentation accuracy, medical necessity and diagnosis 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 clinicians and administrative leadership as needed
Effectively monitor and create reports with detailed feedback for clinicians 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
As may be requested by Management, design and deliver effective new provider training and ongoing training programs to DFCI caregivers and administrative staff on the rules and regulations related to billing compliance, documentation and coding
Assist in the development of new billing compliance guidelines, procedures, and training programs designed to enhance the effectiveness of the billing compliance program, including the participation of 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

Qualifications

Associates Degree preferred.
A minimum of 3-5 years experience in a healthcare coding or billing environment or as a coding/billing auditor
Knowledge of CMS (Medicare and Medicaid) and commercial payers billing and documentation guidelines required
Certified Coder required (AAPC, or AHIMA)
Ability to present findings and discuss issues with providers confidently and effectively
Strong attention to detail and highly organized
Strong interpersonal, analytical and presentation skills
Strong written and oral communication skills
Strong team player with the ability to work well independently and as a group
Ability to work under pressure, multi-task and meet deadlines
Technical capacity to utilize multiple information systems and Microsoft applications

Dana-Farber Cancer Institute is an equal opportunity employer and affirms the right of every qualified applicant to receive consideration for employment without regard to race, color, religion, sex, gender identity or expression, national origin, sexual orientation, genetic information, disability, age, ancestry, military service, protected veteran status, or other groups as protected by law.

Company Description

Dana-Farber Cancer Institute is committed to providing expert, compassionate care to children and adults with cancer, while advancing the understanding, treatment, cure, and prevention of cancer and related diseases.

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