Coding/Billing Compliance Analyst at Partner's Healthcare in Somerville, Massachusetts

Job Description:

Site: Mass General Brigham Incorporated


At Mass General Brigham, we know it takes a surprising range of talented professionals to advance our mission-from doctors, nurses, business people and tech experts, to dedicated researchers and systems analysts. As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community. We place great value on being a diverse, equitable and inclusive organization as we aim to reflect the diversity of the patients we serve.


At Mass General Brigham, we believe a diverse set of backgrounds and lived experiences makes us stronger by challenging our assumptions with new perspectives that can drive revolutionary discoveries in medical innovations in research and patient care. Therefore, we invite and welcome applicants from traditionally underrepresented groups in healthcare - people of color, people with disabilities, LGBTQ community, and/or gender expansive, first and second-generation immigrants, veterans, and people from different socioeconomic backgrounds - to apply.



Job Summary
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.



Qualifications

• 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.

Additional Job Details (if applicable)



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%)

Remote Type


Remote



Work Location


399 Revolution Drive



Scheduled Weekly Hours


40



Employee Type


Regular



Work Shift


Day (United States of America)



EEO Statement:


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.




Mass General Brigham Competency Framework



At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline. Apply Now