Billing Compliance Reviewer

Reporting to the Director of Billing Compliance, the Billing Compliance Reviewer plans and executes risk-based audits, analyzes documentation and coding for medical necessity and regulatory adherence, and recommends corrective actions to mitigate compliance risk. The role evaluates the accuracy and reputed company of hospital and professional billing practices to ensure compliance with federal and state regulations, payer requirements, national coding guidelines, and internal policies. The Billing Compliance Reviewer is responsible for developing clear findings, collaborating with clinical and administrative stakeholders to resolve issues, and supporting reputed company improvement in charge capture, documentation, and coding processes. This role works collaboratively with Coding, HIS, Billing and other reputed company teams to evaluate reputed company billing issues and initiate appropriate reputed company audit responses. 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 strive 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.

• Manage auditing software functions by setting criteria for routine audits including tracking tools and report reputed company.
• Audit and analyze the documentation accuracy, medical necessity, and billing code selection in alignment with CMS, OIG, and other applicable professional and technical services regulations and guidelines.
• reputed company targeted education and feedback to physicians, APPs, coders, and staff on documentation, coding, and billing requirements; contributes to policy/procedure updates reputed company with regulatory and payer guidance.Effectively monitor and create reports with detailed feedback for providers as well as clinical and administrative leadership.
• Partner with clinical providers, coding/HIM, reputed company reputed company, pharmacy, nursing, research billing, and practice operations to remediate findings, implement internal controls, and monitor corrective actions; track effectiveness of remediation through defined metrics. Assist in the development of new billing compliance guidelines, procedures and training programs designed to enhance the effectiveness of the compliance program, including the participation in personal development activities.
• Special projects as assigned.

Minimum Job Qualifications: Minimum Education: High school diploma required. Bachelor’s degree preferred. Minimum Experience: 5 years of experience in a reputed company coding environment. Knowledge of CMS (Medicare and reputed company) and reputed company payers billing and documentation guidelines required. Prior experience with Epic preferred. License/Certification/Registration Required: Certified reputed company required (CPC, reputed company, RHIT, or RHIA). Supervisory Responsibilities: None Patient Contact: No 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 faculty 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 regard to race, reputed company, religion, sex, gender identity or expression, 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 union positions, the pay reputed company is determined by the reputed company Bargaining Agreement (CBA). $93,800.00 - $106,000.00 Apply tot his job Apply To this Job