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Job Details

BWPO Compliance Auditor / 40 hours / Days / Surgery Job

Company name
Brigham and Women's Hospital

Location
Boston, MA

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Profile

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

Qualifications

LICENSES, CERTIFICATIONS, and/or REGISTRATIONS:

Required: CPC

Preferred: CPMA and/or CEMC

EDUCATION:

Minimum Required:

High school diploma or GED Certificate

Some college or Associate's Degree , Doctoral Degree

Field of Study (if applicable):

Required: Knowledge of CMS (Medicare and Medicaid) and other 3 rd 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

EEO Statement

EO Statement:

Brigham and Women's Hospital is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, creed, sex, sexual orientation, gender identity, national origin, ancestry, age, veteran status, disability unrelated to job requirements, genetic information, military service, or other protected status.

Partner's Healthcare is acting as an Employment Agency in relation to this vacancy.

Job Criteria:

Start Date:

Position Type: Full-Time Permanent

Years of Experience Required:

Education Required:

Overnight Travel:

Vacation Time:

Company info

Brigham and Women's Hospital
Website : http://www.brighamandwomens.org

Company Profile
Boston's Brigham and Women's Hospital (BWH) is an international leader in virtually every area of medicine and has been the site of pioneering breakthroughs that have improved lives around the world. A major teaching hospital of Harvard Medical School, BWH has a legacy of excellence that continues to grow year after year. Brigham and Women’s Health Care – the parent corporation for Brigham and Women’s Hospital, Brigham and Women’s Faulkner Hospital and the Brigham and Women’s Physician Organization – includes 150 outpatient practices with over 1,200 physicians. We serve patients from New England, throughout the United States, and from 120 countries around the world.BWH is an internationally-known referral center for the most complex cases in nearly all areas of medicine. In fact, US News and World Report consistently ranks us among the nation’s top ten hospitals and in the top ten for specific specialty areas that in 2015 include cancer, cardiology and heart surgery, diabetes and endocrinology, geriatrics, gynecology, nephrology, neurology and neurosurgery, orthopedics, pulmonology, and rheumatology. The BWH name is a reflection of our history. In 1980 three of Boston’s oldest and most prestigious Harvard Medical School teaching hospitals - the Peter Bent Brigham Hospital, the Robert Breck Brigham Hospital, and the Boston Hospital for Women – merged to form Brigham and Women’s Hospital. As a national leader in improving health care quality and safety, we have helped to develop some of the industry’s best practices including computerized physician order entry (CPOE) to prevent medication errors. The CPOE is now a nationally-accepted safety practice. The BWH Research Institute (BRI) is one of the most powerful biomedical research institutes in the world and the second largest recipient of National Institutes of Health (NIH) funding among independent hospitals in the United States. With over $640 million in total research funding and over 1,000 principal investigators, BWH has long had great success in research as measured by the number of important discoveries made, the size and scope of its research portfolio and the volume of publications annually.

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