Compliance Auditor and Coder - Tarrytown

ENT and Allergy Associates•Tarrytown, NY

2d•Onsite

About The Position

ENT and Allergy Associates, LLP and Hümi is seeking a self-motivated, people-friendly full time Compliance Auditor and Coder for our Tarrytown Corporate office location. The Compliance Auditor and Coder supports the organization’s Compliance Program by conducting risk-based medical record, coding, billing, and documentation audits for professional services. This role evaluates the accuracy and completeness of CPT, ICD-10-CM, HCPCS Level II, and modifier assignment; assesses compliance with applicable federal and state requirements, payer guidance, internal policies, and documentation standards; and identifies opportunities to reduce coding risk, prevent fraud, waste, and abuse, and strengthen revenue integrity. The position also serves as a coding and documentation resource to providers, staff, and management and supports education, corrective action, and follow-up monitoring. Audit priorities may be driven by internal risk assessments, federal and state work plans, payer activity, regulatory guidance, industry alerts, data analytics, external reviews, or management requests.

Requirements

Associate degree in health information management, healthcare administration, business, or a related field required; bachelor’s degree preferred. Relevant experience may be considered in lieu of a degree where appropriate.
Minimum of two (2) years of professional coding, auditing, billing, or related healthcare compliance experience required.
Current coding or auditing certification required, such as CPC, CCS, CCS-P, CPMA, CEMC, CENTC, or an equivalent nationally recognized credential.
Demonstrated knowledge of professional-fee coding, documentation requirements, third-party payer billing practices, and applicable federal and state healthcare compliance requirements.
Working knowledge of Evaluation and Management (E/M) coding and documentation guidelines required.
Proficiency with Microsoft Excel, Word, and PowerPoint

Nice To Haves

Compliance certification, such as CHC or CPCO, preferred.
ENT and/or Allergy specialty coding experience preferred.
experience with electronic health records, practice management systems, audit tools, or data analytics applications preferred.

Responsibilities

Conduct prospective and retrospective audits of medical records and claims to evaluate documentation completeness, medical coding accuracy, modifier use, billing practices, and the timeliness of documentation.
Validate CPT, ICD-10-CM, HCPCS Level II, Evaluation and Management (E/M), and other applicable professional coding assignments against the medical record and relevant guidance.
Identify overcoding, undercoding, unsupported services, documentation gaps, modifier concerns, and other compliance or reimbursement risks.
Analyze audit findings for trends, patterns, variances, root causes, and potential areas of organizational risk.
Prepare clear, accurate, and actionable audit reports that summarize methodology, findings, risk, and recommended corrective actions.
Perform follow-up audits to evaluate the effectiveness and sustainability of corrective action plans and document outcomes for management.
Collaborate with Compliance, Revenue Cycle, Clinical Operations, and other stakeholders on audits, investigations, and special projects as assigned.
Support the administration, monitoring, and continuous improvement of the organization’s Compliance Program and compliance work plan.
Research coding, billing, documentation, and reimbursement requirements and communicate relevant regulatory or payer changes to appropriate stakeholders.
Serve as a resource to providers, employees, and management on coding, documentation, billing, and related compliance policies and procedures.
Assist in identifying the need for new or revised policies, procedures, controls, and education based on audit results, regulatory changes, and emerging risks.
Assist with responses to external audits, medical record requests, and payer or government reviews, including record collection, documentation analysis, and appeal support, as appropriate.
Review identified refunds or overpayments related to audit or committee activity to verify appropriate processing and closure.
Assist with compliance-related coding edits, rules, or other monitoring tools as assigned.
Develop audit-based educational materials and practical coding/documentation guidance for providers and staff.
Participate in individual and group education, including remedial education when audit findings indicate a need for corrective action.
Communicate complex coding and compliance requirements in a clear, professional, and constructive manner.
Maintain current professional knowledge through continuing education, professional organizations, webinars, regulatory publications, and industry resources.
Occasional travel to clinical office locations may be required.
Performs other compliance, coding, auditing, and job-related duties as assigned.