Schedule Details:

Scheduled Hours:

Shift:

Hours:

Cost Center:

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver

At UMass Memorial Health everyone is a caregiver regardless of their title or responsibilities. Exceptional patient care academic excellence and leadingedge research make UMass Memorial the premier health system of Central Massachusetts and a place where we can help you build the career you deserve. We are more than 16000 employees working together as one health system in a relentless pursuit of healing for our patients community and each other. And everyone in their own unique way plays an important part every day.

Major Responsibilities:

• Plans develops and implements the review. Determines scope of review such as number of patient services sample sizes mix of physician/facility services etc.
• Reviews professional and hospital claim form documents in conjunction with patient medical record to ensure appropriate coding and clinical documentation. Also reviews reimbursement documents to validate appropriate reimbursement identify overpayments and/or missed opportunities.
• Prepares presentation of findings and recommends corrective actions to ensure compliance with applicable governmental regulations and organizational policies and procedures.
• Presents to physicians clinicians and/or administrative staff to educate regarding coding billing and documentation requirements to meet government and thirdparty payer requirements.
• Reviews and responds to external audit requests surrounding supervision coding billing and documentation requirements.
• Performs routine risk analyses staying current with governmental workplans and current healthcare events.
• Remains current regarding changes in Medicare and/or Medicaid regulations. Provides educational material and conducts training sessions for applicable organization.
• Participates and assists in seminars on governmental coding billing and documentation rules and regulations.

Position Qualifications:

License/Certification/Education:

Required:

• Bachelors degree in Business Administration Health Care or related field.
• Coding and/or Auditing Certification such as CPC CPMA CEMC CCS CCSP (May consider applicants in process of obtaining with successful completion within one year).

Experience/Skills:

Required:

• Proficient in Evaluation and Management Auditing.
• Strong knowledge in performing riskbased auditing.
• Three to five years of experience with Government Payers (Medicare and Medicaid) as well as large thirdparty health care insurers or integrated health care delivery system thirdparty billing requirements and regulations.
• Strong working knowledge of ICD10 CPT4 to include HCPCS coding is essential.
• Knowledge of charge master and/or DRG coding is a significant plus.
• Strong oral and written communication skills and analytical and presentation skills for interacting with all levels of leadership and staff.
• Must be highly organized and pay strong attention to detail and accuracy.
• Proficient computer skills in Microsoft Office i.e. Word Excel PowerPoint.

Preferred:

• Epic experience.
• MD Audit (Enterprise).

All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity national origin disability or protected veteran status.

Were striving to make respect a part of everything we do at UMass Memorial Health for our patients our community and each other. Our six Standards of Respect are: Acknowledge Listen Communicate Be Responsive Be a Team Player and Be Kind. If you share these Standards of Respect we hope you will join our team and help us make respect our standard for everyone every day.

As an equal opportunity and affirmative action employer UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race color religion gender sexual orientation national origin age disability gender identity and expression protected veteran status or other status protected by law.

If you are unable to submit an application because of incompatible assistive technology or a disability please contact us at We will make every effort to respond to your request for disability assistance as soon as possible.