Department Description: The Compliance Analyst will be supporting the Harvard Medical Faculty Physicians (HMFP) Audit Team.
This position is located in Woburn, MA.
Job Location: Woburn, MA
Req ID: 28351BR
Job Summary: Audits medical record documentation to determine if the documentation sufficiently supports the level of care billed for those services rendered according to Medicare, other federal insurance programs and third party regulations. Provides guidance, training and education when applicable to HMFP Departments throughout the Institution. Collaborates with contract management specialist - BIDCO, billing companies and other needed entities/third party payers to identify and analyze billing guidelines that may impact the overall compliance of the HMFP physicians revenue cycle particularly those related to coding issues. Interacts closely with Technical Analyst to review and audit workfile use and make determinations based on CCI edits and other payer regulations that affect the day-to-day billing processes. Communicates to providers, department administration and billing companies along with suggested corrective action plans and additional training as needed. Interacts extensively with medical staff and other Medical Center personnel.
- Utilizing knowledge of ICD-9 and CPT-4 coding and guidelines for documentation of billings for physicians within the Harvard Medical Faculty Practice (HMFP) on a routine basis, ensures physicians are in compliance with Medicare, other federal insurance programs and third party regulations.
- Provides education and training for the nurse practitioner compliance/billing and credentialing process to HMFP.
- Provides training to HMFP staff on current compliance issues related to the billing process.
- Identifies any charges that need to be corrected for erroneous billing.
- Utilizes billing reports and systems available to identify high-risk areas for auditing.
- High School diploma or GED required. Associate's degree preferred in Business or Healthcare field.
- CPC/CCS-P certification required
- 3-5 years related work experience required.
- Strong knowledge of reimbursement regulations, coding guidelines and compliance policies.
- Current knowledge of ICD-9 and CPT-4 Coding, medical terminology, Medicare, other federal insurance programs and third party billing, and compliance regulations and guidelines.
- Self-motivated, ability to work independently and good interpersonal skills; must possess integrity.
- Experience with computer systems required, including web based applications and some Microsoft Office applications which may include Outlook, Word, Excel, PowerPoint or Access.
- Multi-specialty billing experience.
- Written Communications: Ability to summarize and communicate in English moderately complex information in varied written formats to internal and external customers.
- Oral Communications: Ability to comprehend and communicate complex verbal information in English to medical center staff, patients, families and external customers.
- Knowledge: Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations.
- Team Work: Ability to work collaboratively in small teams to improve the operations of immediate work group by offering ideas, identifying issues, and respecting team members.
- Customer Service: Ability to provide a high level of customer service to patients, visitors, staff and external customers in a professional, service-oriented, respectful manner using skills in active listening and problem solving. Ability to remain calm in stressful situations.
Physical Nature of the Job:
Sedentary work: Exerting up to 10 pounds of force occasionally in carrying, lifting, pushing, pulling objects. Sitting most of the time, with walking and standing required only occasionally
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