BWPO CODING/ COMPLIANCE AUDITOR

Affiliate Name: Brigham & Women's Physicians Organization
Job Category: Financial/Accounting/Billing
Department: BWPO RADIOLOGY
Hours/Week: 40
Job Type: Regular
Employment Type: Full TimeResponsibilities:
GENERAL SUMMARY AND OVERVIEW STATEMENT:
Incumbent will be responsible for review and analysis of coding and compliance activities directly related to reimbursement for professional services. Incumbent will perform audits of Radiologists to ensure that documentation supports the examination that was performed. Each Radiology faculty member will be audited annually, with follow-up audits as needed. Incumbent will be responsible for educating the Radiologists on coding and compliance issues and tracking completion of compliance training.PRINCIPAL DUTIES AND RESPONSIBILITIES:
1.Responsible for preparing audits for each Radiology provider. These audits will include benchmarking against national averages.
2.Responsible for follow-up audits, as needed.
3.Responsible for tracking coding issues by provider and providing necessary education to improve coding and maximize reimbursement. May prepare reports and present findings to management.
4.Responsible for training Radiologists and other members of the Radiology Department on coding and documentation regulations and requirements.
5.Responsible for preparing and distributing billing alerts as necessary.
6.Responsible for reporting and resolving any and all billing issues discovered during provider audits.
7.Keep informed of third party regulations in billing/reimbursement and maintain files of coding publications.
8.Handle special projects as assigned by the Director of Finance and Administration, Senior Vice-Chair for Physician Affairs, and/or Compliance Officer.
9.Participate in continuing education programs to ensure that coding knowledge remains current.
REQUIREMENTS
QUALIFICATIONS:
1.BS Degree preferred
2.5+ years of experience in a healthcare setting including ICD-9 and CPT Coding experience required, preferably with experience in Radiological coding and documentation
3.Knowledge of CMS and other 3rd party payers' billing and documentation requirements, required
4.American Academy of Professional Coders (AAPC) or Certified Coding Specialist (CCS) certification, strongly preferredSKILLS AND ABILITIES REQUIRED
1.Ability to present findings and discuss issues with providers confidently and effectively
2.Strong attention to detail
3.Ability to interact with all levels of staff
4.Strong interpersonal, analytical, and presentation skills
5.Strong written and oral communication skills
6.Strong organizational skills
7.Excellent problem-solving skills
8.In-depth understanding and knowledge of ICD-9 and CPT coding
9.Ability to work both independently and as part of a team
10.Ability to work under pressure, multi-task, and meet deadlines
11.Familiarity with common office equipment and computer software, including MS Office and Database softwareWORKING CONDITIONS
1.Professional office environmentSUPERVISORY RESPONSIBILITY
1.None