12 coding compliance educator jobs found

Billing Compliance Curriculum Development Specialist Dana-Farber Cancer Institute Boston, MA Full Time The Billing Compliance Curriculum Development Specialist is responsible for the design, development, implementation, and evaluation of enterprise-wide billing compliance education programs at Dana-Farber Cancer Institute (DFCI). This role serves as a subject-matter expert in professional and technical billing compliance, with a strong emphasis on oncology services, regulatory requirements, and risk-based education strategies. The position partners closely with Billing Compliance leadership, Revenue Cycle, HIM, Clinical Operations, and Compliance to ensure education is standardized, scalable, evidence-based, and aligned with CMS, OIG, NCCI, payer guidance, and institutional risk priorities. Located in Boston and the surrounding communities, Dana-Farber Cancer Institute is a leader in life changing breakthroughs in cancer research and patient care. We are united...

This position has the primary function of coordinating and supporting the Deputy Chief Compliance Officer with administrative, analytical, and program coordination activities. This position will provide support related to compliance auditing activities and programs, assisting with developing and coordinating the Compliance Audit Plan, supporting proactive and reactive audits of professional fee billings in clinic and facility settings, including federally qualified health centers. Proactively support audit activities related to billing and coding risks to the SOM, identifying and calculating potential overpayments based on audit results, participating in the repayment process if necessary, reviewing research billing compliance issues and assisting the Deputy Chief Compliance Officer in designing and managing a comprehensive billing/auditing program.  The position supports compliance-related activities by gathering information, coordinating documentation reviews, monitoring...

Job Summary Designs and delivers education programs on compliant documentation, coding and billing practices, regulatory requirements, and internal policies through learning experiences such as instructor-led sessions, webinars, and e-learning modules. Serves as a key resource for physicians, clinical staff, auditors, coders, and other stakeholders, ensuring understanding and adherence to applicable standards. Analyzes data and reports to identify educational needs and may conduct limited audits to support targeted training efforts. Essential Functions: Develops and delivers targeted education based on new service or program implementation, CPT/ICD-10 changes, and regulatory changes. Reviews audit data and compliance trends to identify educational gaps and address areas of risk. Designs and maintains educational content and resources, supporting accurate CPT and diagnosis coding for professional services,...

Billing Compliance Reviewer  Dana-Farber Cancer Institute  Boston, MA  Full Time Overview Reporting to the Director of Billing Compliance, the Billing Compliance Reviewer plans and executes risk-based audits, analyzes documentation and coding for medical necessity and regulatory adherence, and recommends corrective actions to mitigate compliance risk. The role evaluates the accuracy and integrity of hospital and professional billing practices to ensure compliance with federal and state regulations, payer requirements, national coding guidelines, and internal policies. The Billing Compliance Reviewer is responsible for developing clear findings, collaborating with clinical and administrative stakeholders to resolve issues, and supporting continuous improvement in charge capture, documentation, and coding processes. This role works collaboratively with Coding, HIS, Billing and other internal and external teams to evaluate complex billing issues and initiate...

Senior Billing Compliance Hospital Reviewer  Dana-Farber Cancer Institute  Boston, MA  Full Time Reporting to the Director of Billing Compliance, the Senior Billing Compliance Reviewer will be responsible for the identification and performance of Billing Compliance inpatient and ambulatory activities. The Senior Reviewer will provide oversight related to reviewing the accuracy and appropriateness of ICD-10-PCS procedure coding and assessing DRG assignment. The Senior Reviewer will assist in the development and execution of the annual Billing Compliance work plan. They will monitor federal and state regulatory requirements and industry developments and work to determine applicability and risk to both technical and operational aspects of the organization. Metrics will be developed and reported quarterly. The Senior Reviewer will be expected to pursue successful completion of multiple tasks collaborating effectively with many departments across the institute, Mass...

Overview: The Documentation and Coding Consultant 1 provides training, consultation, review, and feedback to clinicians on their medical service documentation and coding to ensure KPNW receives appropriate reimbursement and conforms to applicable guidelines and regulations. This is a hybrid position that is a blend of working both remotely and in office. Must reside in the Northwest Service Region (Oregon or Washington). Major Responsibilities / Essential Functions: Consulting and Coding services Provides expert consultation to specialists or primary care clinicians as assigned on coding and documentation education and questions. Within assigned clinical specialties, maintain current knowledge to ensure that KPNW coding and documentation meets regulatory guidelines and audit standards. Follow coding specificity guidelines using coding rules and guidelines. General coding knowledge and understanding of Risk Adjustment models and submission...

ruralMED Management Resources, an Ovation Healthcare partner, seeks a Hospital Outpatient Specialty Coder. This role, under general direction, is responsible for critical access hospital coding; including emergency department, infusions, Critical Access Hospital Specialty Clinic, professional fees, and Rural Health Clinic. They will ensure the timely and accurate coding of medical claims while maximizing reimbursement for services. Duties and Responsibilities: Employee must have the skills, ability and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation.  Specific job duties will vary based upon client assignment.  Employee will also abide by ruralMED’s policies as a condition of employment. Charge Entry Receive and review charge entry data from practice sites Identify and investigate incomplete or missing charges Coding: Abstract clinical information; translates medical...