Job Description

The Physician Billing Coder oversees the department's revenue integrity process by managing coding work queues and reviewing registration and charge interfaces. The role includes auditing clinical documentation, billing, and payment records to ensure compliance with medical records and coding standards. The coder assesses coding accuracy and risk, prepares reports, and provides feedback based on audit findings. They also work with staff and physicians to identify issues and suggest improvements for the revenue cycle process.

Principal Duties and Responsibilities

• Selects then follows established protocols and selects and reviews a percentage of records to assess coding documentation, billing, and/or reimbursement practices for compliance with all regulations of federal and state agencies and third-party payors and hospital policy.
• Review the department coding work queues, ensuring that all physicians are accounted for on the community hospital interface so that charges are received, issues are resolved, and bills are processed in a timely manner.
• Responds to requests for billing information, including billing audit requests and inquiries from Patient Relations regarding professional billing issues.
• Resolves coding issues according to National Correct Coding Initiative (CCI) standards through analysis of medical record documentation and use of CCI standard coding rules. Assesses the level and accuracy of CPT and ICD-10 coding to determine and ensure compliance with governmental and third-party payer regulations. Uses the information gained through this evaluation to prepare reports and provide individual and/or group instruction to physicians and other providers (as needed).
• Validate receipt of registration and charge interface feeds from community hospitals and the coding contractor. Reviews validates, and reconciles messages from interface files. Works closely with ISD and others to investigate and resolve identified issues and contributes to improvements to the electronic interface.
• Develops and maintains professional skills and knowledge through attendance at relevant conferences, seminars, and other educational programs, participation in professional organizations, and review of current literature.
• Contributes to teamwork within and between BCH departments and coding vendors, supporting revenue integrity.
• Provides positive and effective customer service that supports the department's professional billing process and operations.

Schedule: Monday-Friday, business hours. This position will be primarily remote after training period.

To qualify, you must have:

• Associate's Degree in health information management. Bachelor's preferred.
• Certified Professional Coder (CPC) certification required.
• Experience in Health Information Management and 5 years experience reviewing physician documentation and assisting physicians in meeting government and other third-party payer coding requirements.
• Experience in providing individual and group physician training.
• Knowledge of healthcare compliance regulations.
• Understanding of professional billing revenue cycle and its impact on collections.
• Analytical skills for complex problem-solving and system/process design across departments.
• Strong communication and writing skills for addressing complex issues and mediating solutions.
• Familiarity with Epic EMR and billing modules is preferred.
• Ability to review physician documentation and guide compliance with payer requirements.
• Knowledge of CPT and ICD-10 coding through training sessions.

Boston Children's Hospital offers competitive compensation and unmatched benefits including flexible schedules, affordable health, vision and dental insurance, childcare and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and certain License and Certification Reimbursement, cell phone plan discounts and discounted rates on T-passes.

About Boston Children's Hospital

Boston Children's Hospital is a 395-bed comprehensive center for pediatric health care. As one of the largest pediatric medical centers in the United States, Children's offers a complete range of health care services for children from birth through 21 years of age.

Connections working at Boston Children's Hospital

Job Tags

For contractors, Flexible hours, Monday to Friday,

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