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Children's Hospital Boston Hospital Billing Compliance Manager in Boston, Massachusetts

67357BRJob Posting Title:Hospital Billing Compliance ManagerDepartment:Billing ComplianceAutoReqId:67357BRStatus:Full-TimeStandard Hours per Week:40 Job Posting Category:Legal ServicesJob Posting Description:In 2022, for the 9th year in a row, BCH was named the #1 pediatric hospital in the country, making it the clear destination for families seeking answers about their child’s health. Our commitment to excellence for our patients, their families and to the community is the fabric of who we are and what we strive for. Our Billing Compliance Department is seeking a Hospital Billing Compliance/Education Manager to focus on hospital billing initiatives with expertise on hospital billing compliance regulations. This candidate will have experience in hospital billing and coding, understand the intricacies of hospital billing, and be ready to translate the most complex clinical hospital scenarios to compliant hospital billing.

The Hospital Billing Compliance Manager will be responsible for:

  • Develop, implement, and oversee focused, technical educational programs for providers and BCH employees who support providers to promote regulatory compliance with documentation and billing requirements.

  • Establish and maintain working relationships with all providers to identify, assess and assist in mitigating regulatory risk through education. Plan and facilitate implementation of educational programs

  • Partner closely with Billing Compliance Auditors to assess and address risks identified during audits. Review audit reports regularly as means of determining educational needs and to gather insights for program development. Complete documentation and billing audits when needed.

  • Initiate inquiries involving documentation and billing compliance issues. Make recommendations consistent with regulatory requirements for coding, documentation and billing to assure services are submitted according to payer guidelines and related regulations. Ensure compliance issues are addressed.

  • Partner with the Director of Billing Compliance to complete the annual compliance risk assessment process and audit work plan development. Establish and maintain criteria to monitor and evaluate compliance education effectiveness.

  • Serve on or lead interdisciplinary and departmental committees and task forces as a subject matter expert and authoritative resource on documentation and billing requirements.

  • Develop and maintain professional skills and knowledge through attendance at relevant conferences, seminars and other educational programs, participation in professional organizations and review of current literature.

To qualify, you must have:

  • A Bachelor’s degree in Health Information Management or Nursing and 3+ years of medical coding or reimbursement experience such as ICD-10-CM and CPT-4coding. It also requires knowledge of corporate compliance regulations and billing.

  • 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.

  • Previous experience in development and delivery of compliance education programs for professional and hospital related billing is strongly preferred.

  • Work requires the ability to work with diverse internal and external constituencies Coding certifications from AAPC and/or AHIMA (CPC, CPC-H, CCS-P, CCS) is required.

  • Certification in Health Care Compliance (CHC) required or obtained within first 6 months of employment.

  • This is a hybrid position requiring 1 day in the office and 4 days remote if you live in MA, RI, NH or ME

Boston Children’s Hospital offers competitive compensation and unmatched benefits, including affordable health, vision and dental insurance, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition Reimbursement, cell phone plan discounts and discounted rates on T-passes (50% off). Discover your best.

*LI Office/Site Location:BrooklineRegular, Temporary, Per Diem:Regular

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