Compliance - Baystate Health

Req#: R20808
Category(s): Legal/Compliance/Risk, Compliance
Full Time / Part Time: Per Diem
Shift: First


Responsible for performing a variety of diversified duties in connection with reviews of medical record documentation for professional billing to ensure it meets the AMA and CMS (Medicare) guidelines for the services billed, reviewing and validating billed charges and performing benchmark reporting to determine outliers. Completes a variety of analyses and reports and maintains various department databases. The incumbent routinely interacts with employees at all levels. The incumbent has an understanding of compliance audit concepts. This includes but is not limited to relaying confidential information, gathering and interpreting information to help develop various reports, develop and maintain compliance audit work papers following department standards. The incumbent uses discretion and judgment when screening visitors and telephone calls, and managing the PBO Compliance, Audit and Education office. Creates complex spreadsheets and other documents. Represents the department in resolving problems and exchange of information, interpretation of departmental policy and procedures. Adheres to system and department policies, and any and all applicable laws and regulations. Performs other duties as assigned. 70% of the work is compliance audit related and 30% of the work is administrative.

Job Responsibilities: 

1) Performs detailed reviews of clinical documentation for provider services using MDAudit based on determined intervals per provider. Validates appropriate billing and documentation that complies with governmental and commercial carrier guidelines. Reviews billing documentation to identify areas where appropriate improvement to billing or documentation would enable more accurate billing.

2) Validates and identifies appropriate ICD-9 (ICD-10) diagnosis coding as it pertains to specific risk adjustments and correct coding.

3) Assists in preparing administrative reports, statements, roster, etc. Performs data and/or information gathering, creates spreadsheets, drafts and prepares special reports analyses for review by management.

4) Performs Pathology and Radiology coding; applicable use of all carrier guidelines and review of clinical documentation.

5) Receives and screens incoming correspondence, reports, memos, etc., and prepares appropriate responses to routine inquiries.

6) Schedules meetings, conferences, interviews, and appointments, completes travel arrangements and maintains Manager(s) business calendar.

7) Develops, maintains, and revises record-keeping and filing systems, and classifies, sorts and files correspondence, articles, records and other documents.

8) Assists in monitoring department budgets and provides an accounting for budget line items in assigned cost centers. Initiates and prepares expenditures for office supplies, standard department inventory, travel, etc., and accepts receipts and invoices for non-routine expenditures.

9) Proficiency with Microsoft Office products including Word, Excel, PowerPoint, Outlook. Computer literacy with ability to use a variety of tools.

Required Work Experience: 

1) 2 Years Office/Practice Experience

Preferred Work Experience: 

1) 2 Years Office/Practice Experience and 1-years of Coding

Skills and Competencies: 

1) None Listed

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.



GED or HiSET (Required)


Certified Coding Specialist – American Health Information Management Association, Certified Compensation Professional – Other

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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