At Boston Children's Hospital, success is measured in patients treated, parents comforted and teams taught. It's in discoveries made, processes perfected, and technology advanced through major medical breakthroughs and small acts of kindness. And in colleagues who have your back and patients who have your heart. As a teaching hospital of Harvard Medical School, our reach is global and our impact is profound. Join our acclaimed Department of Compliance organization and discover how your talents can change lives. Yours included.
This Professional Billing Compliance Manager will be responsible for:
Overseeing the day to day operations of the professional billing compliance program at Boston Children's Hospital (BCH), including, but not limited to professional billing compliance audits; professional billing compliance training; consultative professional billing services; and other items pertaining to billing the professional component of services.
Developing and overseeing the professional billing compliance auditing program, which assesses BCH billing clinicians regulatory compliance with documentation and billing requirements.
Planning and facilitating implementation of formal educational programs to the BCH community which address compliant billing for the professional component of health care services.
Serving as a technical resource to the professional compliance auditors for documentation and billing questions and regulatory interpretation.
Updating management regarding progress reports related to audit completion by compliance auditors, and additional applicable information, as required.
Initiating inquiries involving documentation and billing compliance issues, making recommendations consistent with regulatory requirements for coding, documentation and billing to assure services are submitted according to payor guidelines and related regulations. Ensures compliance issues are addressed and resolved.
The oversight, response and follow-up pertaining to Federal, State and third party payer audits of professional services. Communicates to key stakeholders regarding audit findings and corrective actions, if required.
Serving on or leading interdisciplinary and departmental committees and task forces as a subject matter expert and authoritative resource on documentation and billing requirements for professional services.
To qualify, you must have:
A High School diploma or equivalent required; A Baccalaureate degree preferred, and four to six years of coding experience for professional services utilizing ICD-10-CM and CPT-4 coding principles and experienced applying these principles to medical record documentation.
Demonstrated working knowledge of corporate compliance regulations and billing.
SME analytical skills to collect information from diverse sources, apply professional principles in performing various analyses, and summarize the information and data in order to solve problems.
Collaborative Communication skills in order to effectively deal with conflicting views or issues and mediate fair solutions.
The ability to communicate effectively both orally and in writing, providing empathy in difficult interpersonal situations.
Experience working with diverse internal and external constituencies.
Coding certifications from AAPC and/or AHIMA (CPC, CCS-P) required.
Boston Children's Hospital offers competitive compensation and unmatched benefits, including an affordable health, vision and dental insurance, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition Reimbursement, and discounted rates on T-passes (50% off). Discover your best.
Boston Children's Hospital is an Equal Opportunity / Affirmative Action Employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, sex, sexual orientation, gender identity, protected veteran status or disability.
Internal Number: 2812618
About Boston Children's Hospital
Boston Children's Hospital is a 395-bed comprehensive center for pediatric health care. As one of the largest pediatric medical centers in the United States, Children's offers a complete range of health care services for children from birth through 21 years of age.