Billing Compliance Auditor III (hybrid)

Boston Children’s Hospital; Boston (MA); Hybrid; USD 70,000 - 90,000; Full time

Job summary

Boston Children’s Hospital is seeking a Billing Compliance Auditor III to perform audits of clinical documentation and billing records. The role is hybrid and emphasizes accuracy, compliance, and process improvement.

The auditor will prepare reports, train staff, and help develop billing policies in coordination with CHB Foundations and Hospital leadership. Applicants should have a High School Diploma or GED, CPC or CCS-P certification, and at least three years of CPT/ICD-10 coding experience,

Qualifications

• Education: High School Diploma or GED required; higher education preferred.
• Certification: CPC or CCS-P (Professional Billing Coding) required.
• Experience: 3 years CPT and ICD-10 coding experience, incl. reviewing physician documentation.

Responsibilities

• Audit clinical documentation, physician billing and payment records for compliance with regulations and policy.
• Assess coding accuracy and risk; determine compliance with federal, state, and payer rules.
• Prepare reports and provide guidance to physicians and staff based on audit results.
• Draft billing and coding policies in coordination with Hospital leadership.
• Respond to external billing audit requests as needed.

Skills

CPT coding

ICD-10 coding

Documentation review

Auditing

Education

High School Diploma/GED

Associates or Bachelors preferred

Professional Billing Coding certification (CPC/CCS-P)

Job description

Position Summary

Billing Compliance Auditor III (hybrid). Under general supervision performs audits of clinical documentation, physician billing and payment records and applicable industry standard codes by analyzing medical records, coding records and health system bills validating clinical documentation in conjunction with the bill; assessing the level and accuracy of coding, determining that governmental and third party payer regulations are being complied with; and evaluating appropriateness of billing and coding procedures. Evaluates accuracy and risk level of coding and billing performance by individuals and clinical units. Prepare reports and provide individual and/or group instruction to physicians and others based on results of audit. Works collaboratively with appropriate personnel to identify and recommend strategies for process improvement and to develop and draft billing and coding policies for the CHB Foundations in coordination with the Hospital. Assists in response to billing audit requests from outside the institution e.g., government audits, payer audits.

Key Responsibilities

• Following established protocols selects and reviews a percentage of records to assess coding documentation, billing and/or reimbursement practices for compliance with all regulations of federal and state agencies and third party payers and hospital policy.
• Maintains review data and provides feedback to relevant areas in collaboration with appropriate personnel. Assigns performance scores and risk rating based on audit results.
• In conjunction with appropriate personnel, investigates, evaluates and identifies opportunities for improvement and recognizes their relative significance in the overall system and provides guidance to departments regarding internal controls.
• Develops and drafts billing and coding policies for the CHB Foundations in coordination with the Hospital. Develops and maintains professional skills and knowledge through attendance at relevant conferences, seminars and other educational programs, participation in professional organizations and review of current literature.
• Contributes to the teamwork within and between departments and organizations that support hospital operations.
• Provides positive and effective customer service that supports departmental and hospital operations.

Minimum Qualifications

Education: High School Diploma/GED required. Associates Degree or Bachelors Degree preferred

Certification required: Professional Billing Coding certification (CPC, CCS-P)

Experience: 3 years CPT and ICD10 coding experience; including some experience reviewing physician documentation and assisting physicians to meet required