"Billing Compliance Reviewer"

Billing Compliance Reviewer

Reporting to the Director of Billing Compliance, the Billing Compliance Reviewer will be responsible for review and analysis of coding and compliance activities directly related to reimbursement for professional and technical services to ensure Federal and State regulatory requirements are met, and the program aligns with industry standards. The Billing Compliance Reviewer is responsible for meeting with providers 1:1 post-audit and educating them on proper documentation, coding, and charge entry. This role 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.

Located in Boston and the surrounding communities, Dana-Farber Cancer Institute 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 related diseases. We strive to create an inclusive, diverse, and equitable environment where we provide compassionate and comprehensive care to patients of all backgrounds, and design programs to promote public health particularly among high-risk and underserved populations. We conduct groundbreaking research that advances treatment, we educate tomorrow's physician/researchers, and we work with amazing partners, including other Harvard Medical School-affiliated hospitals.

Primary Duties and Responsibilities:

• Manage auditing software functions by setting criteria for routine audits including tracking tools and report generation.
• 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.
• Conduct post-audit education 1:1 with providers audited.
• Effectively monitor and create reports with detailed feedback for providers 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.
• 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.
• 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.

Knowledge, Skills and Abilities:

• Ability to present findings and discuss issues with providers confidentially 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.

Minimum Job Qualifications:

Minimum Education:
High school diploma required. Bachelor’s degree preferred.

Minimum Experience:
3 years of experience in a healthcare coding environment. Knowledge of CMS (Medicare and Medicaid) and commercial payers billing and documentation guidelines required. Prior experience with Epic preferred.

License/Certification/Registration Required:
Certified Coder required (CPC, CCS, RHIT, or RHIA).

Supervisory Responsibilities:
None

Patient Contact:
No

Pay Transparency Statement
The hiring range 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 range is determined by the Collective Bargaining Agreement (CBA).
$84,000.00 - $91,300.00