CHARGE AUDIT ANALYST Job in Boston 02114, Massachusetts Us
Description:
Responsible to coordinate all activities pertinent to charge audits being conducted at Brigham Women’s Hospital in accordance with the BWH/MGH Charge Audit Policy and established departmental policies/procedures.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
1. Coordinates the scheduling of audits with external Third Party Audit Representatives, to initiate the charge audit process
2. Prepares detailed audit packages for cases selected by Audit Representatives, including itemized bills and other necessary document needed to initiate the audit process
3. Ensures that accounts selected for audit are in compliance with PHS internal policies and/or payor guidelines
4. Coordinates or requests medical records for preparation of third party/charge audits, including patient authorizations as defined by the PHS Charge Audit Policies
5. Supports and defends hospital charges and obtains additional documentation to finalize audit
6. Conducts exit interviews with Audit Representatives and follow-up as needed
7. Adheres to PHS Charge Audit policies, principles, and practices as they relate to billing audits
8. Maintains internal systems used for tracking and reporting of findings, including but not limited to, patient accounting systems, spreadsheets, databases, and to facilitate monthly management reporting
9. Documents and summarizes findings in a clear, concise, and effective manner to facilitate improvements in the charge capture process and submission of root cause analysis
10. Develops and maintains professional working relationships with external customers and audit representatives.
11. May be responsible for keying agreed upon charge audit discrepancies off accounts in the appropriate system.
12. Identifies ongoing issues with charging and documentation, and reviews audit reports with the appropriate personnel from revenue integrity to work toward prevention of future losses.
13. Provides Audit Representatives with an orientation to the hospital’s Audit Policy and Procedures.
Qualifications:
The audit coordinator should have knowledge, experience and expertise in the following areas:
• Minimum of 2 years of billing audit experience.
• Format and content of a medical record and various forms of medical/clinical documentation.
• Medical Terminology and coding including CPT and HCPCS.
• State and Federal regulations concerning the use, disclosure and confidentiality of patient records
• Auditing principles and standards as applicable to charge audits.
• Billing and charge capture procedures and claim forms, such as the UB92.
SKILLS/ ABILITIES/ COMPETENCIES REQUIRED:
• Excellent oral and written communication skills.
• Ability to interact with all levels of health care personnel and hospital/finance management.
• Strong organizational and time management skills.
• Ability to work independently in a role that requires flexibility in an environment that is deadline driven.
• Ability to identify root cause of issues uncovered in the charge audit process and make recommendations for corrective actions.
• Experience with computer software programs such as Word and Excel are required.
• Ability to function as a department resource with a focus on contributing to the achievement of departmental and corporate goals.
WORKING CONDITIONS:
This position is based in the Cross-town office and will require working on-site with Audit Representatives/Departmental Personnel at Brigham and Women’s Hospital approximately 50% of the time..
Salary/Benefits: Salary commensurate with experience
Partners HealthCare offers a comprehensive benefits package, including a choice of six medical plans, two dental plans, prescription drug and vision coverage, generous Paid Time Off, disability coverage, retirement plans, flexible spending accounts, and tuition reimbursement.
Job Location: Boston, MA
Job Number: 11787
Company URL: http://www.partners.org
Company Profile:
Founded by Brigham and Women's Hospital and Massachusetts General Hospital, Partners HealthCare is a network of integrated hospitals and physicians providing cutting-edge patient care, teaching, and research. Over 3,000 professionals work behind the scenes to help keep Partners at the forefront of medicine, including those in Information Systems, Finance, Human Resources, Development, Real Estate, Legal Counsel, Business Planning, and other administrative capacities. Enjoy the benefits of a strong, stable organization; the largest health system in New England and the largest non-government employer in Massachusetts.
Partners Healthcare System is an Equal Opportunity Employer.
