Compliance - Baystate Health

Req#: R15613
Category(s): Legal/Compliance/Risk, Compliance
Full Time / Part Time: Full-Time
Shift: First

The Compliance, Audit and Education Specialist is 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. Work in partnership with clinical providers, medical directors, chairmen, managers, directors and internal customers to ensure maximization and integrity of the billing process.

Posting Description:

Reporting to the Manager of Provider Revenue Integrity, the Specialist’s accountabilities include identification, interpretation and dissemination of new carrier guidelines for leaders, staff and providers. Engages providers on new guidelines or resolving issues as it pertains to billing and documenting patient services. Excellent communication skills are essential for success in this role; the ability to communicate with managers, directors, team members, providers, billers and coders. The Specialists clinical areas include Heart and Vascular, Critical Care, Gastroenterology, Neonatal and Pediatric Critical Care.  This position requires excellent coding skills, compliance/documentation knowledge and the ability to work collaboratively with providers.

Job Responsibilities: 

1) Identify, validate and ensure corporate compliance for providers through evaluation of billing patterns, routine audits and comprehensive educational sessions focusing on areas of specialty.

2) Collaborate with practice leadership to evaluate new patient services, appropriate billing, documentation and reimbursements to ensure maximization of revenue in a compliant environment.

3) Annual review, reporting and education of coding functions to include appropriate coding and data entry for all provider services.

4) Provide consultative services to clinical practices to include evaluation of services provided, appropriate coding, reimbursement, carrier guidelines, clinical documentation and creation of billing tools.

5) Evaluation and resolution of complex reimbursement issues originating from the professional billing staff and under the direction of the Sr. Compliance, Audit & Education Specialist.

6) Communication of carrier and governmental guidelines to key stakeholders providing clinical services as well as billing staff responsible for ensuring appropriate billing.

7) Acquisition of carrier fee schedules with in-depth review and report to senior leadership on financial impact for all Baystate Medical Practices clinical areas.

Required Work Experience: 

1) 3-5 years coding/billing provider medical services

Preferred Work Experience: 

1) 5-7 years coding/billing provider medical services

Skills and Competencies: 

1) 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, expertise in auditing provider documentation to ensure compliance while maximizing revenue through appropriate billing, competencies with electronic health records, audit tools and all Microsoft production software and expertise at collaboration with coding staff, practice staff, practice management, directors and providers to identify process improvements for charges

2)  Proficiency with Microsoft Office products including Word, Excel, PowerPoint, Outlook

You Belong At Baystate

At Baystate Health we know that treating one another with dignity and equity is what elevates respect for our patients and staff. It makes us not just an organization, but also a community where you belong. It is how we advance the care and enhance the lives of all people.



Bachelor of Arts, GED or HiSET (Required)


Certified Professional Coder – American Academy of Professional Coders

Equal Employment Opportunity Employer

Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.

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