Senior Billing Compliance Reviewer

Overview

Reporting to the Director of Billing Compliance, the Senior Billing Compliance Reviewer will be responsible for the identification and performance of Billing Compliance inpatient and ambulatory activities. The Senior Reviewer will assist in the development and execution of the annual Billing Compliance work plan. They will monitor federal and state regulatory requirements and industry developments and work to determine applicability and risk to both technical and operational aspects of the organization. They will also manage all external hospital billing compliance audit activity including timely response, process improvement and corrective action plans from implementation through completion. Metrics will be developed and reported quarterly. The Senior Reviewer will be expected to pursue successful completion of multiple tasks collaborating effectively with many departments across the institute, Mass General Brigham Healthcare and Boston Children’s Hospital. The ideal candidate is organized, independent, ethical, and motivated.

Located in Boston and the surrounding communities, Dana-Farber Cancer Institute is a leader in life changing breakthroughs in cancer research and patient care. We are united in our mission of conquering cancer, HIV/AIDS, and related diseases. We strive to create an inclusive, diverse, and equitable environment where we provide compassionate and comprehensive care to patients of all backgrounds, and design programs to promote public health particularly among high-risk and underserved populations. We conduct groundbreaking research that advances treatment, we educate tomorrow's physician/researchers, and we work with amazing partners, including other Harvard Medical School-affiliated hospitals.

Primary Duties and Responsibilities:

• Assist in creation and manage execution of annual Billing Compliance work plan for services including focused audits as they arise. Audits to be performed each year are identified based on the then-current Office of the Inspector General work plan and internal and external compliance risk analysis.
• Process paybacks including report generation, check requests, cover letters and supporting documentation as required for delivery to Chief Compliance Officer for final submission to payer.
• Review government and commercial payer policy updates (i.e., MCR NCD/LCD), regulatory, legal and industry developments for their applicability to the operation, determine risks and participate in the dissemination of relevant information.
• Manage audit software functions by setting criteria for routine and focused professional and technical audis including tracking tools and reports generation. Interface with audit software Help Desk and other staff to troubleshoot issues and implement software program changes.
• Utilize audit software reports, manage external hospital audits, including 60-day response cycle for government audits and conduct education as necessary or needed.
• Coordinate, assist and/or conduct billing compliance investigations as required, which may include audits designed to review the adequacy of medical record documentation to support claims as well as inquiries into suspected or reported deviation from billing compliance program requirements.
• Design and complete quarterly reporting metrics.
• Assist in the development of new billing compliance guidelines, procedures and training programs designed to enhance the effectiveness of billing compliance program, including participation of personal development activities.
• Attend and actively participate in various meetings which may include CPT-Epic, New Services, Regional Campuses, Inpatient Billing, ADCC and AAMC as well as other continuous quality improvement processes and workgroups as needed.
• Serve as a liaison and collaborate with business partners (revenue cycle, nursing, clinical operations, HIS, ancillary departments, etc.).
• Work with the educator to enhance existing training programs, documentation tools and tip sheets.
• Special projects as assigned.

Knowledge, Skills and Abilities:

• Strong interpersonal skills, including ability to establish and maintain effective relationships with providers, leadership, senior administration, colleagues, and billing compliance staff.
• Excellent written and verbal communications, facilitation, and presentation skills used to share audit findings, risk areas and billing compliance issues identified.
• Ability to work independently with limited supervision and willingness to be flexible depending on department needs.
• Ability to balance and manage multiple priorities and flexibility to reprioritize tasks when needed.
• Knowledge of various audit software, Epic and/or other comparable software and database tools.
• Knowledge of hospital operations, reimbursement, and applicable regulatory requirements.
• Ability to present findings and discuss issues with providers and other staff confidentially and effectively.
• Strong attention to detail and highly organized.
• Strong team player with ability to work well independently and as a group.
• Ability to work under pressure, multitask and meet deadlines.
• Technical capability to utilize multiple information systems and Microsoft applications.

Minimum Job Qualifications:

Minimum Education:
High school diploma required. Bachelor’s degree preferred.

Minimum Experience:
5 years of experience in healthcare coding including at least 1 year of prior auditing experience. Knowledge of CMS (Medicare and Medicaid) and commercial payers billing and documentation guidelines, current coding resources, including CPT4, ICD-10-CM/PCS, HCPCS required.

License/Certification/Registration Required:

Certified Coder required (CPC, CCS, RHIT, or RHIA).

Supervisory Responsibilities:

None

Patient Contact:

No

Work Location
- Fully remote. The selected candidate may work remotely from Washington D.C. or any state in the U.S. (except Hawaii).

Salary Range and Benefits for Positions Approved for National Recruitment
• Base salary range: $94,900 - $105,700. The hiring range is based on market pay structures, with individual salaries determined by factors such as business needs, market conditions, internal equity, and based on the candidate’s relevant experience, skills and qualifications.
• For union positions, the pay range is determined by the Collective Bargaining Agreement (CBA)
Dana-Farber offers eligible full and part-time staff members benefits, including health and wellness benefits, retirement, and paid time off. A summary of benefits offered can be found at .

Application Window
Dana-Farber will accept applications on an ongoing basis until a qualified candidate is identified or Dana-Farber closes the requisition.

At Dana-Farber Cancer Institute, we work every day to create an innovative, caring, and inclusive environment where every patient, family, and staff member feels they belong. As relentless as we are in our mission to reduce the burden of cancer for all, we are committed to having faculty and staff who offer multifaceted experiences. Cancer knows no boundaries and when it comes to hiring the most dedicated and compassionate professionals, neither do we. If working in this kind of organization inspires you, we encourage you to apply.

Dana-Farber Cancer Institute is an equal opportunity employer and affirms the right of every qualified applicant to receive consideration for employment without regard to race, color, religion, sex, gender identity or expression, national origin, sexual orientation, genetic information, disability, age, ancestry, military service, protected veteran status, or other characteristics protected by law.

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Pay Transparency Statement

The hiring range is based on market pay structures, with individual salaries determined by factors such as business needs, market conditions, internal equity, and based on the candidate’s relevant experience, skills and qualifications.

For union positions, the pay range is determined by the Collective Bargaining Agreement (CBA).

$94,900.00 - $105,700.00