Senior Compliance Auditor (JR229173)

Montefiore Hudson Valley Collaborative; New York (NY); On-site; USD 70,000 - 90,000; Full time

Job summary

A healthcare organization in New York seeks an experienced individual to safeguard revenue and reputation through auditing and compliance activities. Responsibilities include conducting medical record audits, developing formal reports for senior management, and coordinating education sessions for over 500 health professionals. The ideal candidate must have a Bachelor's degree, at least 5 years of relevant experience in billing and coding, and excellent communication skills.

Qualifications

• Minimum 5 years of billing, coding, and documentation experience in a hospital setting required.
• Coding certification (such as CCS, CPC, RHIA, RHIT) or ability to obtain within one year of hire.
• Familiar with both facility and professional documentation, coding, and billing rules.

Responsibilities

• Safeguards Montefiore Medical Center revenue and reputation through various audit activities.
• Coordinates and performs medical record audits of documentation, coding, and billing.
• Develops formal audit reports and presents findings to senior management.
• Conducts documentation, coding, and billing curriculum and education for over 500 professionals.

Skills

Billing

Coding

Documentation

Communication

Analytical skills

Education

Bachelor Degree

Job description

Introduction

To heal, to teach, to discover and to advance the health of the communities we serve.

To learn more about the “Montefiore Difference” – who we are at Montefiore and all that we have to offer our associates, please click here.

Overview

Safeguards Montefiore Medical Center revenue and reputation, through the following activities:

Responsibilities

• NY Office of Medicaid Inspector General (OMIG)
• Office of Inspector General (OIG)
• Medicaid Fraud Control Unit (MFCU)
• NY Attorney General (AG)
• NY Department of Health (DOH)
• Centers for Medicare and Medicaid Services (CMS)
• National Government Services (NGS)
• Medicaid Integrity Program Contractor (MIC)
• Recovery Audit Contractor (RAC)
• Zone Program Integrity Contractor (ZPIC)
• Health Care Fraud Prevention and Enforcement Action Team (HEAT)

• Communicates with external agencies regarding audits.
• Participates in development of voluntary disclosures and repayments to federal and state agencies.
• Coordinates, supervises, and performs medical record audits of documentation, coding and billing for technical and professional services, including:
  • CPT
  • ICD9
  • HCPCII
  • DRG
  • APC
  • APG
  • Modifiers
  • Teaching Physician Guidelines
  • Non-Physician Practitioner Documentation (including "incident-to" guidelines)
• Conducts audits of electronic and manual documentation, coding, and billing systems.
• Develops formal audit reports of findings and recommendations, which are presented to senior management of applicable department, the Executive Compliance Committee and the Board of Trustees.
• Conducts close-out meetings with senior management of applicable department.
• Coordinates audit activities with Internal Audit, as necessary.
• Identifies compliance risk areas and develops action plans accordingly.
• Develops and coordinates analysis of encounter forms and documentation templates.
• Audits and enforces compliance policies and procedures.
• Develops and conducts documentation, coding and billing curriculum and education classes for 500+ physicians, allied health professionals, and coding and billing associates annually, including:
  • One-on-one education sessions based on audit findings
  • Topic-specific group education
  • Mandatory Compliance education
  • Compliance Monthly education calendar sessions
  • Grand Rounds
  • Monthly Faculty Meetings
• Assists in development and distribution of MediRegs risk assessments to various departments to determine inclusion in annual work plan.
• Assists with distribution of all Medicare and DOH updates and code changes to the appropriate associates.
• Facilitates responses to compliance-related inquiries (phone, e-mail, in-person).

Requirements

• Bachelor Degree Required
• Minimum 5 Years of Billing, Coding, and Documentation experience in a hospital setting Required
• Coding certification (such as CCS, CPC, RHIA, RHIT)/ability to obtain within one year of hire Required.
• Needs to be familiar with both facility and professional documentation, coding and billing rules and regulations.
• Needs to be able to navigate registration, billing, and documentation systems with ease.
• Knowledge of local, state, and federals rules and regulations.
• Able to communicate with all level associates, including senior management and external agencies.
• Excellent written and oral communication skills.
• Highly organized and analytical individual needs to be able to function with a high level of independence, motivate and train associates while maintaining good working relationships.