Children's Hospital Boston Senior Physician Billing Compliance Auditor in Boston, Massachusetts

Title Senior Physician Billing Compliance Auditor

Department Billing Compliance

Job Posting Description

At Boston Children’s Hospital, success is measured in patients treated, parents comforted and teams taught. It’s in discoveries made, processes perfected, and technology advanced. In major medical breakthroughs and small acts of kindness. And in colleagues who have your back and patients who have your heart. As the teaching hospital of Harvard Medical School, our reach is global and our impact is profound. Join our acclaimed Billing and Compliance Team and discover how your talents can change lives. Yours included.

This position is responsible for:

  • Performing audits of clinical documentation, physician billing and payment records and applicable industry standard billing codes by analyzing medical records, coding records and health system bills validating clinical documentation in conjunction with the bill; assessing the level and accuracy of coding, determining that governmental and third party payer regulations are being complied with; and evaluating appropriateness of billing and coding procedures.

  • Evaluating accuracy of coding and billing performance by individuals and clinical units.

  • Preparing reports and providing individual and/or group education to physicians and others based on results of audit.

  • Working collaboratively with appropriate personnel to identify and recommend strategies for process improvement and to develop and draft billing and coding policies for the CHB Foundations in coordination with the Hospital.

  • Assisting in response to billing audit requests from outside the institution (e.g., government audits, payer audits).

To qualify you must have:

  • The level of knowledge typically acquired through completion of a Bachelor’s degree in Health Information Management or Nursing and three to five years experience reviewing physician documentation and assisting physicians to meet government and other third party payer and CPT and ICD9 coding requirements through individual and group training sessions.

  • Strong knowledge of healthcare compliance regulations and focused experience in one or more medical specialties, a plus.

  • 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.

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

This position is eligible for an Employee Referral Bonus.

Boston Children’s Hospital offers competitive compensation and unmatched benefits, including an affordable health, vision and dental insurance, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition Reimbursement, cell phone plan discounts and discounted rates on T-passes (50% off). Discover your best.

Boston Children’s Hospital is an Equal Opportunity / Affirmative Action Employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, sex, sexual orientation, gender identity, protected veteran status or disability.

*LI-JH1

Status Full Time

Shift Day

Schedule (i.e. Mon. - Fri.) mon fri

Standard Hours per Week 40

AutoReqId 42551BR