Key Facts

Remote From:

Full time

English

Hard Skills

Medical Billing ICD 503 Cppunit Contract Management Medical Necessity Fraud Detection Billing Regulatory Compliance Medical Coding Root Cause Analysis Clinical Documentation Electronic Health Record Applications Claims And Litigation Management Complaint Investigations

Other Skills

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Collaboration
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Communication
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Analytical Skills
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Teamwork
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Detail Oriented
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Problem Reporting
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Social Skills
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Problem Solving

Roles & Responsibilities

Education: High School Diploma or Equivalent required.
Experience: 1-2 years in medical billing, claims processing, or coding within a healthcare environment, with a strong focus on third-party payer guidelines and regulations.
Knowledge, Skills and Abilities: In-depth knowledge of coding systems (ICD-10-CM, CPT, HCPCS) and billing requirements across various healthcare settings; familiarity with HIPAA, CMS guidelines, and NCCI edits; strong analytical skills and attention to detail; proficiency in billing software and electronic health record (EHR) systems; excellent communication and interpersonal skills.

Requirements:

Review medical claims and billing documentation to ensure accuracy, completeness, and compliance with regulatory requirements, coding guidelines, and payer policies.
Verify the appropriateness of billed services, procedures, and diagnosis codes, and identify potential compliance issues including incorrect coding or other billing irregularities.
Conduct audits to ensure adherence to HIPAA and CMS guidelines and evaluate the accuracy and adequacy of clinical documentation to support billed services and medical necessity.
Analyze claim denials and collaborate with billing and coding teams to resolve discrepancies and resubmit claims as needed.

Brigham and Women's Hospital

About Brigham and Women's Hospital

Boston's Brigham and Women's Hospital (BWH) is an international leader in virtually every area of medicine and has been the site of pioneering breakthroughs that have improved lives around the world. A major teaching hospital of Harvard Medical School, BWH has a legacy of excellence that continues to grow. With two outstanding hospitals, over 150 outpatient practices, and over 1,200 physicians, we serve patients from New England, throughout the United States, and from 120 countries around the world. The BWH name is a reflection of our history. In 1980 three of Boston’s oldest and most prestigious Harvard Medical School teaching hospitals - the Peter Bent Brigham Hospital, the Robert Breck Brigham Hospital, and the Boston Hospital for Women – merged to form Brigham and Women’s Hospital. As a national leader in improving health care quality and safety, we have helped to develop some of the industry’s best practices including computerized physician order entry (CPOE) to prevent medication errors. The CPOE is now a nationally-accepted safety practice. The BWH Biomedical Research Institute (BRI) is one of the most powerful biomedical research institutes in the world and the second largest recipient of National Institutes of Health (NIH) funding among independent hospitals in the United States. BWH has long had great success in research as measured by the number of important discoveries made, the size and scope of its research portfolio and the volume of publications annually. BWH is a training ground for physicians, nurses, and allied health professionals. We have 1,100 trainees in over 140 of the most sought after training programs in the world, and also host Harvard Medical School students in rotations throughout our programs. As our global health services expand, our clinical trainees have rich opportunities to contribute and learn in challenging environments around the world. Brigham and Women's Hospital is an EEO, AA, VEVRAA Employer.

Founded: 2018

Company size: 10001

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Job description

Site: Mass General Brigham Incorporated

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Job Summary

Responsible for conducting thorough and accurate reviews of healthcare billing and claims documentation

Essential Functions
-Review medical claims and billing documentation to ensure accuracy, completeness, and compliance with regulatory requirements, coding guidelines, and payer policies.
-Verify the appropriateness of billed services, procedures, and diagnosis codes.
-Identify potential compliance issues, including incorrect coding, unbundling, upcoding, and other billing irregularities.
-Conduct audits to ensure adherence to industry regulations, such as HIPAA and CMS guidelines.
-Evaluate the accuracy and adequacy of clinical documentation, ensuring it supports the billed services and complies with medical necessity guidelines.
-Collaborate with healthcare providers to obtain additional information or clarification, if necessary.
-Analyze claim denials and rejections, identify root causes, and recommend corrective actions to prevent future denials.
-Work closely with billing and coding teams to resolve claim discrepancies and resubmit claims, if needed.
-Identify potential fraudulent activities or abuse in billing practices.
-Report suspicious activities and work with internal compliance teams and external agencies to investigate and resolve fraud cases.

Qualifications

Education
High School Diploma or Equivalent required

Licenses and Credentials

Experience
Experience in medical billing, claims processing, or coding within a healthcare environment, with a strong focus on third-party payer guidelines and regulations. 1-2 years preferred

Knowledge, Skills and Abilities
- In-depth knowledge of coding systems (e.g., ICD-10-CM, CPT, HCPCS) and billing requirements across various healthcare settings.
- Familiarity with billing and coding compliance regulations, such as HIPAA, CMS guidelines, and National Correct Coding Initiative (NCCI) edits.
- Strong analytical skills and attention to detail, with the ability to review and interpret complex billing and coding documentation.
- Proficiency in using billing software and electronic health record (EHR) systems.
- Excellent communication and interpersonal skills, with the ability to collaborate effectively with internal teams, healthcare providers, and insurance companies.

Additional Job Details (if applicable)

• M-F Eastern Business hours required for remote role; flexibility for shifts to range between 6AM- 6PM EST
• Quiet, secure, stable, compliant work station required

Remote Type

Remote

Work Location

399 Revolution Drive

Scheduled Weekly Hours

Employee Type

Regular

Work Shift

Day (United States of America)

Pay Range

$19.81 - $28.30/Hourly

Grade

At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

EEO Statement:

0100 Mass General Brigham Incorporated is an Equal Opportunity Employer. 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. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

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.

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