Baystate Health is seeking a Full-time Compliance Audit & Education Specialist
As the Baystate Compliance Audit and Education Specialist you will be responsible for providing advisory services for all aspects of provider billing and education as it applies to professional services within Baystate Medical Practices and Baystate Health. You will work in partnership with clinical providers, medical directors, chairmen, managers, directors and internal customers to ensure maximization and integrity of the billing process.
What You Will Do:
- You will be asked to identify, validate and ensure corporate compliance for providers through evaluation of billing patterns, routine audits and comprehensive educational sessions focusing on areas of specialty.
- Collaborate with practice leadership to evaluate new patient services, appropriate billing, documentation and reimbursements to ensure maximization of revenue in a compliant environment.
- Annual review, reporting and education of coding functions to include appropriate coding and data entry for all provider services.
- Provide consultative services to clinical practices to include evaluation of services provided, appropriate coding, reimbursement, carrier guidelines, clinical documentation and creation of billing tools.
- Evaluation and resolution of complex reimbursement issues originating from the professional billing staff and under the direction of the Sr. Compliance, Audit & Education Specialist.
- Communication of carrier and governmental guidelines to key stakeholders providing clinical services as well as billing staff responsible for ensuring appropriate billing.
What You Will Need:
- High School Diploma or equivalent required. Bachelor’s Degree preferred.
- Minimum 3-5 years of coding/billing for provider medical services required, 5-7 years’ experience preferred.
- Certified Professional Coder (CPC) or Certified Coding Specialist (CCS-P) required.
- Exemplary communication skills; ability to navigate challenging conversations and provide effective provider training.
- In-depth knowledge of carrier guidelines as they apply to provider services as well as expertise in auditing provider documentation to ensure compliance while maximizing revenue through appropriate billing.
- Proficiency with Microsoft Office products including Word, Excel, PowerPoint, Outlook.
What You Need To Know:
- Schedule- 40 hours per week
- Location- 280 Chestnut Street, Springfield, MA.