Coding/Billing Compliance Analyst

We’re focused on a people-first culture for our system’s patients and our professional family. That’s why we provide our employees with more ways to achieve their potential. Partners HealthCare is committed to aligning our employees’ personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal development—and we recognize success at every step.

Our employees use the Partners HealthCare values to govern decisions, actions and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.

Under the supervision of the Manager, Coding & Billing Compliance for Partners Healthcare, the Senior Compliance Coding and Billing Auditor/Analyst (Sr. Analyst) is responsible for participating in the monitoring of existing and emerging coding and billing compliance risks, identifying higher risk areas and assisting in evaluating these risks. The Sr. Analyst is responsible for “following risk areas through” by working with management to identify proposed solutions and assisting in developing tools such as policies and training materials to support issue resolution going forward.

To be successful in this role, the Sr. Analyst should have a working knowledge of Medicare requirements, including coding, medical record documentation and billing standards and an ability to effectively research requirements and complete an applicability and impact analysis. Successful candidates must be able to understand, apply and interpret complex billing rules in a variety of treatment settings and healthcare-related government regulations, including Medicare and Medicaid. Clinical knowledge, analytical and critical thinking skills are required to conduct compliance audits and draft reports. Work is performed in a team environment with direct supervision by the Compliance Coding/Billing Manager, therefore strong collaboration and communication skills are important.

The duties of the Sr. Analyst will include the performance of audits pertaining to outpatient CPT assignment, assessment of modifier usage, charge capture and billing activities. The Sr. Analyst may also serve as department subject matter expert for regulatory compliance coding and billing by attending meetings and/or assisting the Manager of Coding and Billing Compliance in the development of coding compliance education materials. The Sr. Analyst will present a personal example of ethics and compliance, promote a culture of compliance throughout the organization, and work to strengthen the Corporate and entity compliance programs.

Responsibilities:

• Execution of coding and billing audits in accordance with the Department’s annual work plan and standards.
• Work collaboratively with Manager of Coding and Billing Compliance and other team members to identify and assess coding and billing compliance risks.
• Maintain a working knowledge of applicable regulatory guidance and serve as a subject matter expert in coding and billing compliance as it relates to key areas such as CPT-4, HCPCS, ICD-9 CM and ICD-10 coding as well as payer-specific guidelines.
• Ability to effectively and efficiently research coding and billing guidance.
• Assist coding and patient accounting departments in resolving denials or error queue rejections.
• Work closely with employees at all levels of Partners and Affiliate entities to promote a culture of compliance and strengthen the compliance program.
• Communicate with co-workers using a high level of professionalism and a customer service orientation.
• Demonstrate professionalism and service excellence in all endeavors.
• Present at all times a personal example of ethical and compliant behavior.
• Maintain confidentiality and discretion regarding all work matters.
• Demonstrate outstanding work ethic and work cooperatively with all team members and clients with a can-do spirit and team attitude.
• Assist in special projects as needed

• Associate or bachelor’s degree in a health science profession or comparable education preferred
• Procedural, diagnostic coding certification through American Health Information Management Association (AHIMA) Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or Certified Coding Specialist (CCS) or Certified Coding Specialist-Physician-based (CCS-P) or American Academy of Procedural Coders, Certified Professional Coder (CPC) or Certified Professional Coder-Hospital (CPC-H) required in practice area, AHIMA certification preferred over AAPC certification
• Minimum 3 years of CPT-4 coding and/or experience as well as knowledge of evaluation and management coding required, 2-3 years of compliance coding/billing auditing preferred, ICD-10 coding experience preferred
• Knowledge of Medicare hospital and physician reimbursement methodologies and related revenue cycle processes, including experience reviewing and interpreting coding and billing coverage documents
• Experience with electronic medical record systems (EMR) and in-depth knowledge and understanding of system documentation and coding processes. EPIC experience preferred
• Strong organizational, analytical, critical thinking and motivational skills required.
• Proficient with spreadsheet (Excel) and word processing software.
• Ability to effectively communicate (written and verbally).
• Self-motivated and have the ability to work well with clients, leaders, and colleagues

Mass General Brigham 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.