Bwpo Compliance Auditor / 40 Hours / Days / Surgery

Brigham And Women's Hospital Boston , MA 02298

Posted 5 months ago

Incumbent will be responsible for review and analysis of coding and compliance activities directly related to reimbursement for professional services in the Department of Surgery. Incumbent will perform audits of clinicians to ensure that documentation supports the service that was performed. Incumbent will be responsible for educating the clinicians on coding and compliance issues.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

  • Responsible for preparing audits for each provider. These audits will include benchmarking against national averages.

  • Responsible for follow-up audits, as needed.

  • Responsible for tracking coding issues by provider and providing necessary education to improve coding.

  • Responsible for preparing reports and presenting findings to management.

  • Responsible for educating providers post-audit on coding and documentation regulations and requirements.

  • Responsible for reporting and resolving all billing issues discovered during provider audits.

  • Keep informed of third party regulations in billing/reimbursement and maintain files of coding publications.

  • Handle special projects as assigned.

  • Participate in continuing education programs to ensure that coding knowledge remains current.

  • Assist manager in reviewing external payer audits

  • Assist manager in performing all tasks related to coding and compliance.

  • Perform other duties as needed.

SKILLS/ABILITIES/COMPETENCIES REQUIRED:

  • Ability to present findings and discuss issues with providers confidently and effectively

  • Strong attention to detail

  • Ability to interact with all levels of staff

  • Strong interpersonal, analytical, and presentation skills

  • Strong written and oral communication skills

  • Strong organizational skills

  • Excellent problem-solving skills

  • In-depth understanding and knowledge of ICD-10-CM and CPT coding

  • Ability to work both independently and as part of a team

  • Ability to work under pressure, multi-task, and meet deadlines

  • Familiarity with common office equipment and computer software, including MS Office and Database software

LICENSES, CERTIFICATIONS, and/or REGISTRATIONS:

Required: CPC

Preferred: CPMA and/or CEMC

EDUCATION:

Required: High school diploma or GED Certificate

Preferred: Some college or Associate's Degree, Doctoral Degree

Field of Study (if applicable):

Required: Knowledge of CMS (Medicare and Medicaid) and other 3rd party payers' billing and documentation requirements is required

Preferred: American Academy of Professional Coders (AAPC) CPMA or CEMC, strongly preferred

EXPERIENCE:

Required: 5 years of experience in a healthcare setting including ICD-10-CM and CPT Coding experience is required


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Bwpo Compliance Auditor / 40 Hours / Days / Surgery

Brigham And Women's Hospital