Compliance Audit & Edu Conslt

Baystate Medical Center

Job Description

Job ID 84684
Full / Part Time: Full-Time
Location: 280 Chestnut Street
Regular/Temporary: Regular

Baystate Health (BH) is one of New Englands leading and largest integrated health care organizations, serving a population of nearly one million people throughout western New England. With roots dating back to the founding of Springfield City Hospital in 1873, Baystate Health has been providing high-quality and compassionate health care in western Massachusetts for more than 145 years. With more than 12,000 employees, a medical staff of nearly 3,100 physicians, and a net patient service revenue of more than $1.4 billion, the ever-growing health system includes five Massachusetts hospitals and the Baystate Mary Lane Outpatient Center in Ware:
Baystate Medical Center in Springfield
Baystate Childrens Hospital (located at Baystate Medical Center)
Baystate Franklin Medical Center in Greenfield
Baystate Wing Hospital in Palmer
Baystate Noble Hospital in Westfield

Baystate Health is led by Mark A. Keroack, MD, MPH, who became President and Chief Executive Officer in 2014. The nationally recognized integrated delivery system whose mission is to improve the health of the people in our communities every day, with quality and compassion also includes more than 80 medical practices, home care and hospice services, comprehensive regional laboratory and diagnostic services, and Health New England, a health insurance provider with over 160,000 members.

A recognized leader in educational innovation, Baystate Medical Center has been training the doctors of tomorrow since 1914 and today has major programs in postgraduate medical education with residencies in Medicine, Surgery, Anesthesiology, Radiology, Pathology, OB/GYN, Pediatrics, Medicine-Pediatrics, Emergency Medicine, and Psychiatry, along with more than 24 fellowship programs.

In 2017, Baystate welcomed the first medical students to its Springfield campus as part of the new UMASS Medical School-Baystate the only regional, clinical campus of the University of Massachusetts in Worcester offering an innovative approach to primary care medicine called the Population-based Urban and Rural Community Health track (PURCH). PURCH offers medical students the opportunity to practice medicine in diverse underserved urban and rural communities and to focus on health care issues common to that population. The partnership also resulted in the creation of the Institute for Healthcare Delivery and Population Science (IHDPS), a collaborative effort between UMMS, Baystate Health, and UMass Amhersts School of Public Health and Health Sciences (SPHHS), which develops, implements and evaluates innovative strategies to transform the delivery of health care services.

Responsible for oversight of coding and reimbursement for all Baystate Medical Practice sites. Works in collaboration with senior management for Finance/clinical practices to ensure maximization of revenue through accurate coding, identification and resolution of reimbursement issues through education.

Provides leadership for professional billing and coding on highly visible health system initiatives; advocating for clear and concise billing functionality, documentation coding and workflow changes to enhance the revenue flow.

Develops key strategic relationships with commercial and governmental carrier senior-level staff to resolve professional reimbursement and coding issues, audits and payment discrepencies.

Identify, communicate, educate and ensure resolution of high-level reimbursement issues providing guidance to Compliance Specialists, Billing Operations and Coding to positively impact the prompt adjudication of claims.

Responsible for oversight of the professional coding operation; ensure creation of processes, effectiveness of coding, accuracy of coding and conduct weekly, monthly and annual training to all coders for Baystate Medical Practices.
Provides advisory services on high-level health system initiatives as the experts on professional billing and coding to ensure maximization of revenue through accurate and timely charge flow.
Provide leadership to the Compliance, Audit and Education Specialists for reimbursement, coding and audit issues as it pertains to professional billing.
Identification and creation of documentation for key reimbursement and coding changes. Coordinate communication with management and Compliance Staff.
Proactively coordinate monitoring, evaluation and resolution of complex reimbursement issues. Develop and implement strategies and processes to reduce denials.
Oversight of all audit functions for Baystate Medical Practices ensuring current coding and reimbursement guidelines are applied accurately and consistently.
Liaison with all governmental and commercial carriers for escalation and resolution of reimbursement and coding issues identified through billing operations; provide communication to senior management.
Development of policies and procedures as they pertain to professional coding and reimbursement.

Minimally Required Education / Certifications:
High School / GED
5+ years coding/billing provider medical services
Certified Professional Coder (CPC) or Certified Coding Specialist (CCS-P)

Expertise in ICD-9 and CPT coding principles
Excellent communication skills
Ability to manage difficult conversations
Financial stewardship to ensure maximization of revenue while maintaining compliance
Iin-depth knowledge of governmental and carrier guidelines
Ability to interpret, identify risks, determine financial impact and communicate at an executive level
Capable of taking a leadership role on strategic initiatives and expertise in creating stimulating, educational, effective training programs for both providers and staff
Proficiency with Microsoft Office products including Word, Excel, Powerpoint and Outlook