Beth Israel Deaconess Medical Center Billing and Compliance Auditor in Boston, Massachusetts

Billing and Compliance Auditor

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Job LocationBoston, Massachusetts

Req ID 18300BR

Department Description: The Department of Pathology is integrally involved with the diagnosis of cancer and other major medical conditions through the gross and microscopic examination of tissue samples obtained from surgical procedures and endoscopy (Anatomic Pathology). Our department also provides clinical laboratory services to the hospital as well as consult services in the areas of clinical chemistry, hematopathology, microbiology, and transfusion medicine (Clinical Pathology).

This is a full time 40 hours per week position Monday to Friday 8.30am to 5.00pm.Job Location: Boston, MAReq ID: 18300BRJob Summary: Maintain the HMFP Pathology charge master for all HMFP Pathology locations within the network (currently, BIDMC, Needham and Milton) by accurately identifying the professional services provided by the Department, and match the most accurate CPT code.

Essential Responsibilities:

  • Understand and possess a working knowledge of ICD9 codes and their use in order to provide the pathologists with training, education and written policies and procedures.

  • Form the basis for transitioning to ICD10 in 2014. Select of appropriate codes, assist with populating LIS dictionaries at each of the HMFP Pathology pro-fee locations and train the pathologists at each location in preparation for the use of the new coding system.

  • Act as the main liaison between the HMFP Pathology departments and the external billing agency. Troubleshoot, problem solve and respond to all billing inquiries efficiently and effectively.

  • Provide ongoing audits of work billed for accuracy. Report findings to management and HMFP Corporate Compliance Officer. Work with the individual pathologist to rectify errors and/or retrain as needed. Communicate appropriate information to the external billing company and/or Hospital PFS as needed.

  • Prepare and present various management reports for tracking, trending and monitoring billing metrics.

Required Qualifications:

  • Bachelor's degree required in Hospital Administration or other relevant.

  • Certificate 1 preferred: Certified Professional Coder, and Prefer candidate with CPC coding certification or compliance training.

  • 3-5 years related work experience required in Prefer candidate with 3-5 years experience in coding.

  • Knowledge and understand of professional fee billing a major skill requirement.

  • Solid ability to analyze, audit and resolve data discrepancies and develop corrective tools to resolve repetitive data issues.

  • Understanding the requirements for cpt coding and ICD9 coding and their relationship to professional fee billing is key.

  • Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis and maintain databases.

Preferred Qualifications:

  • Prefer candidate with 3-5 years experience in coding


  • Written Communications: Ability to communicate clearly and effectively in written English with internal and external customers.

  • Oral Communications: Ability to comprehend and communicate complex verbal information in English to medical center staff, patients, families and external customers.

  • Knowledge: Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations.

  • Team Work: Ability to act as a team leader for small projects or work groups, creating a collaborative and respectful team environment and improving workflows. Results may impact the operations of one or more departments.

  • Customer Service: Ability to provide a high level of customer service and staff training to meet customer service standards and expectations for the assigned unit(s). Resolves service issues in the assigned unit(s) in a timely and respectful manner.

Physical Nature of the Job:

Sedentary work: Exerting up to 10 pounds of force occasionally in carrying, lifting, pushing, pulling objects. Sitting most of the time, with walking and standing required only occasionally