Inpatient Billing Compliance Reviewer

Job Description

Overview

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 perform audits of inpatient medical record documentation and charges to ensure that documentation supports the service that was performed and billed for professional and institutional services. Reviewer is responsible for meeting with providers 1:1 post-audit and educating them on proper inpatient documentation, coding and charge entry. Works collaboratively with Coding, HIS, billing and other internal and external teams to evaluate complex billing issues and initiate appropriate internal and external audit responses.

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

• Associate’s 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’ inpatient billing and documentation guidelines required
• Certified Coder required (AHIMA or AAPC)
• 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 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.