SENIOR COMPLIANCE AUDITOR

This position safeguards the hospital's 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
  • ICD10
  • 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 1,900 + 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 of risk areas and audit creation in MDaudit
  • 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)

Education/Skills:

Candidate must have a minimum of a bachelors degree. Masters or experience working with auditing/consulting company prefered, as well as certification/credential consistent with role and subject matter expertise (ability to obtain credential within one year of employment).

Applicable credentials include RHIA, CCS, CPC; compliance certification desirable but not required (CHC); desire/ability to obtain encouraged.

Minimum of 5 years background/experience and subject matter expertise in professional and/or hospital coding, billing and revenue cycle, as well as HIM operations required.

bBth professional and hospital inpatient and outpatient experience/subject matter expertise preferred.

Knowledge of state and federal documentation, coding and billing rules/regs.

Ability to engage/communicate with associates/leaders at all levels through health system.

Experience/proficiency in public speaking, leading group and individual educational sessions for providers, coders, billers, others; excellent writing and analytical skills.

HIghly organized with ability to independently conduct research and present findings/relay information to other departments/teams on various compliance, documentation, coding and finance related topics in order to support greater medical center and health system needs from a subject matter expertise perspective.

Demonstrated ability towork independently without much intervention.

Department: Compliance Bargaining Unit: Non Union Campus: MOSES  Employment Status: Regular Full-Time Address: 3349 Steuben Avenue, Bronx
Shift: Day Scheduled Hours: 8:30 AM-5 PM Req ID: 218139 Salary Range/Pay Rate: $69,000.00 - $92,000.00    

For positions that have only a rate listed, the displayed rate is the hiring rate but could be subject to change based on shift differential, experience, education or other relevant factors.

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

Diversity, equity and inclusion are core values of Montefiore. We are committed to recruiting and creating an environment in which associates feel empowered to thrive and be their authentic selves through our inclusive culture. We welcome your interest and invite you to join us.

Montefiore is an equal employment opportunity employer. Montefiore will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law. 

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