Senior Compliance Auditor
About The Position
Safeguards Montefiore Medical Center revenue and reputation, through the following activities: • Participates in external government audits, including: 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
Responsibilities
- Participates in external government audits, including: 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).
Benefits
- An assortment of insurance products and discount programs through Voluntary Benefits.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
5,001-10,000 employees
