Coding/Billing Compliance Analyst

Mass General Brigham (Enterprise Services); Somerville (MA); On-site; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare organization seeks a compliance auditor to analyze medical coding and billing processes. The ideal candidate will ensure adherence to industry regulations and identify improvement opportunities. This position requires a Bachelor's degree in Health Information Management and relevant experience in coding and auditing.

Qualifications

• 2-3 years of experience preferred in medical coding, billing, or compliance auditing.
• In-depth knowledge of coding systems and billing regulations required.

Responsibilities

• Conduct comprehensive audits of medical coding and billing for compliance.
• Monitor practices to identify trends and compliance risks.
• Stay updated on coding regulations and ensure compliance.

Skills

Analytical skills

Attention to detail

Communication skills

Knowledge of ICD-10, CPT, HCPCS

Education

Bachelor's Degree in Health Information Management

Tools

Healthcare software applications

Electronic Health Record (EHR) systems

Job description

Summary
Responsible to analyze and audit medical coding and billing processes to identify potential compliance issues, discrepancies, and opportunities for improvement.
Essential Functions
-Conduct comprehensive audits of medical coding, billing, and documentation practices to assess compliance with industry regulations and internal policies.
-Monitor coding and billing practices on an ongoing basis to identify trends, patterns, and potential compliance risks.
-Stay updated on changes in coding and billing regulations, including those from CMS, CPT, and other governing bodies, to ensure compliance.
-Review medical documentation to ensure alignment with billed services and coding specificity requirements.
-Evaluate the accuracy and appropriateness of diagnostic and procedural codes assigned to medical services.

• Bachelor's Degree in Health Information Management or related field of study required

• 2-3 years of experience preferred in medical coding, billing, compliance auditing, or a related role within the healthcare industry

Knowledge, Skills and Abilities

• In-depth knowledge of coding systems (ICD-10, CPT, HCPCS) and billing guidelines, as well as compliance regulations related to healthcare billing and coding.

• Analytical and critical thinking skills to conduct audits and identify compliance issues.

• Excellent written and verbal communication skills to effectively communicate compliance findings and recommendations.

• Attention to detail and the ability to work independently and collaboratively in a team-oriented environment.

• Proficiency in using healthcare software applications and electronic health record (EHR) systems.

Physical Requirements

Standing Occasionally (3-33%)

Walking Occasionally (3-33%)

Sitting Constantly (67-100%)

Lifting Occasionally (3-33%) 20lbs - 35lbs

Carrying Occasionally (3-33%) 20lbs - 35lbs

Pushing Rarely (Less than 2%)

Pulling Rarely (Less than 2%)

Climbing Rarely (Less than 2%)

Balancing Occasionally (3-33%)

Stooping Occasionally (3-33%)

Kneeling Rarely (Less than 2%)

Crouching Rarely (Less than 2%)

Crawling Rarely (Less than 2%)

Reaching Occasionally (3-33%)

Gross Manipulation (Handling) Constantly (67-100%)

Fine Manipulation (Fingering) Frequently (34-66%)

Feeling Constantly (67-100%)

Foot Use Rarely (Less than 2%)

Vision - Far Constantly (67-100%)

Vision - Near Constantly (67-100%)

Talking Constantly (67-100%)

Hearing Constantly (67-100%)

Mass General Brigham Incorporated is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.