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SENIOR COMPLIANCE AUDITOR

BRONX, NY, US


This 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).

 

Skills/Education: 

Bachelor's Degree required.  Five years experience. **Coding certification (such as CCS, CPC, RHIA, RHIT)/ ability to obtain within one year of hire. 

In-depth knowledge of and proficiency with clinical coding and classification systems, including:  ICD-10 CM & PCS, HCPC/CPT, applicable with physician and hospital inpatient, outpatient and DRG prospective payment systems

Extensive knowledge of and hands-on experience with applying advanced medical coding and claims auditing techniques

In depth knowledge of Medicare, Medicaid, other local, state, federal and private payer coding, billing and reimbursement guidelines

Ability to interpret and relay complex government payor guidelines to other departments and physicians in a manner to identify and resolve coding issues or errors

Ability to analyze and resolve coding and claim issues, errors and denials as a result of edits and provide guidance to Patient Accounts/Billing and Revenue Cycle Departments

In depth knowledge of the principles of healthcare compliance and ability to apply compliance concepts to auditing of medical records and respective claims data

Familiarity with both facility and professional documentation, coding and billing rules and regulations 

Demonstrated ability to navigate registration, billing, and documentation systems with ease  (Epic)

Excellent written and oral communication skills

Experience with all MS Office products (Word, Excel, Powerpoint)

 

 

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: 145101 

 

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. 

 

#GDMD; #LI-VK1; N/A 


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

Vision:
To be a premier academic medical center that transforms health and enriches lives.

Values
Define our philosophy of care, they shape our actions and motivate and inspire us to pursue excellence and achieve the goals we have set forth for the future. Our values include:

  • Humanity
  • Innovation
  • Teamwork
  • Diversity
  • Equity