Billing Compliance Auditor III (hybrid)

Boston Children's Hospital; Boston (MA); Hybrid; USD 70,000 - 100,000; Full time

Benefits offered by this job

Flexible schedules

Comprehensive health, vision andDental

Retirement plan (403b)

Tuition and certification reimburse

Paid time off and employee discounts

Job summary

Boston Children's Hospital is seeking a Billing Compliance Auditor III (hybrid) to review clinical documentation and physician billing, ensuring coding accuracy and regulatory compliance across payer systems. The role evaluates risk, prepares audit reports, and collaborates on process improvements and policy drafting with CHB Foundations in coordination with the Hospital.

Requirements include a high school diploma, CPC/CCS-P certification, and 3 years of CPT/ICD-10 coding experience with E/M

Qualifications

• 3 years CPT and ICD-10 coding experience.
• Experience with E/M coding/auditing and physician documentation.
• Knowledge of healthcare billing compliance regulations.

Responsibilities

• Follows established protocols; selects and reviews records to assess coding, billing and reimbursement practices for compliance with regulations.
• Maintains review data and provides feedback to relevant areas; assigns performance scores and risk ratings.
• Investigates and identifies opportunities for improvement; guides departments on internal controls.
• Develops and drafts billing and coding policies for the Foundations in coordination with the Hospital.
• Develops and maintains professional skills through conferences, seminars and literature reviews.
• Contributes to teamwork across departments and provides positive customer service.

Skills

CPT coding

ICD-10 coding

E/M auditing

Healthcare billing compliance

Education

High School Diploma/GED

Associate's or Bachelor's degree preferred

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 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 as well as E/M coding/auditing experience; including some experience reviewing physician documentation and assisting physicians to meet knowledge of healthcare billing compliance regulations.

The posted pay range is Boston Children’s reasonable and good‑faith expectation for this pay at the time of posting.

Any base pay offer provided depends on skills, experience, education, certifications, and a variety of other job-related factors. Base pay is one part of a comprehensive benefits package that includes flexible schedules, affordable health, vision and dental insurance, child care and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and certain License and Certification Reimbursement, employee discounts and discounted commuter benefits at certain locations. Experience the benefits of passion and teamwork.