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Sr Billing Compliance Auditor

Job ID 147408 Date posted 07/19/2018

Position Summary:
To perform audits of both the hospital and professional clinical documentation to ensure billing compliance with the various regulatory agencies, such as Medicare, to ensure full compliance with all rules and regulations.

Essential Duties & Responsibilities including but not limited to:
- Performing audits of clinical documentation, physician billing and payment records and applicable industry standard billing 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.
- Evaluating accuracy of coding and billing performance by individuals and clinical units.
- Preparing reports and providing individual and/or group education to physicians and others based on results of the audit.
- Working collaboratively with appropriate personnel to identify and recommend strategies for process improvement and to develop and draft billing and coding policies for Lahey Health System.
- Assisting in response to billing audit requests from outside the institution (e.g., government audits, payer audits).


Education: Bachelors degree in Health Information Management or Nursing

Licensure, Certification & Registration:
Professional Billing Coding certification (CPC, CCS-P)

Experience: 3-5 years experience reviewing physician documentation and assisting physicians to meet government and other third party payer and CPT and ICD 10 coding requirements through individual and group training sessions

Skills, Knowledge & Abilities: Strong knowledge of healthcare compliance regulations and focused experience in one or more medical specialties, a plus.
The analytical skills to collect information from diverse sources, apply professional principles in performing various analyses, and summarize the information and data in order to solve problems or design relatively complex systems and programs that cross department/divisional lines.
Excellent communication skills in order to effectively deal with conflicting views or issues and mediate fair solutions, and well developed writing skills.



About Lahey Health

The Lahey Model of Care - right care, right time, right place - is exactly what patients, providers and payers need and deserve. Identifying and delivering on this convergence of interests has positioned Lahey Health for further growth. Our model ensures care is highly coordinated and locally delivered, with lower costs and exceptional quality.

Lahey Health is a robust, regional system including a teaching hospital, community hospitals, primary care providers, specialists, behavioral and home health services, skilled nursing and rehabilitation facilities, and senior care resources throughout northeastern Massachusetts and southern New Hampshire. The system has a global presence with programs in Canada, Jordan and Bermuda.

How To Apply

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