Senior Compliance Auditor

Montefiore Health System•New York, NY

1d•Onsite

About The Position

Safeguards Montefiore Medical Center revenue and reputation, through various auditing and compliance activities. This role involves participating in external government audits, communicating with external agencies, developing voluntary disclosures and repayments, and coordinating/performing medical record audits. The position also requires conducting audits of electronic and manual systems, developing audit reports, conducting close-out meetings, identifying compliance risk areas, and developing action plans. A significant part of the role includes developing and conducting educational classes on documentation, coding, and billing for a large number of healthcare professionals. Additionally, the Senior Compliance Auditor assists with distributing updates and code changes, and facilitates responses to compliance-related inquiries.

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) Required.
Familiarity with both facility and professional documentation, coding and billing rules and regulations.
Ability to navigate registration, billing, and documentation systems with ease.
Knowledge of local, state, and federal rules and regulations.
Ability to communicate with all levels of associates, including senior management and external agencies.
Excellent written and oral communication skills.
Highly organized and analytical individual.
Ability 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), and Health Care Fraud Prevention and Enforcement Action Team (HEAT).
Communicates with external agencies regarding audits.
Participates in the 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, and 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 departments, the Executive Compliance Committee, and the Board of Trustees.
Conducts close-out meetings with senior management of applicable departments.
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 over 500 physicians, allied health professionals, and coding and billing associates annually, including one-on-one education sessions, topic-specific group education, mandatory compliance education, compliance monthly education calendar sessions, Grand Rounds, and Monthly Faculty Meetings.
Assists in the development and distribution of MediRegs risk assessments to various departments to determine inclusion in the annual work plan.
Assists with the 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).