Senior Compliance Auditor (JR229173)

<strong>To heal, to teach, to discover and to advance the health of the communities we serve.<br /></strong><br /> <p>To learn more about the &ldquo;Montefiore Difference&rdquo; &ndash; who we are at Montefiore and all that we have to offer our associates, please click <strong><a href="https://healthymebenefits.com/" target="_blank" title="Montefiore Difference" rel="noopener noreferrer">here</a></strong>.&nbsp;</p>

Bronx, New York

Montefiore

<h4 class=""><strong>WHY TOP TALENT PICKS MONTEFIORE EINSTEIN&nbsp;<br /><br /></strong>Since its inception in 1884, Montefiore Einstein&rsquo;s mission has been to heal, to teach, to discover and advance the health of the communities we serve.<br /><br />Montefiore Einstein&rsquo;s state-of-the-art facilities include the&nbsp;<span class="">internationally-recognized</span>&nbsp;Children&rsquo;s Hospital at Montefiore Einstein and our Notable Centers of Excellence - Montefiore Einstein Center for Cancer Care, Montefiore Einstein Center for Heart and Vascular Care, Montefiore Einstein Center for Transplantation. Combined with a growing number of locations throughout the Bronx and Westchester County, Montefiore Einstein is the ideal organization to apply and hone your expertise.<br /><br /><span style="text-decoration: underline;"><a href="https://montefiore.wd12.myworkdayjobs.com/en-US/MMC/login" target="_blank" title="Candidate Home" rel="noopener noreferrer">Sign In</a></span>&nbsp;- Candidate Home<br /><span style="text-decoration: underline;"><a href="https://montefiore.wd12.myworkdayjobs.com/en-US/MMC/introduceYourself" target="_blank" title="Introduce Yourself " rel="noopener noreferrer">Introduce Yourself&nbsp;</a></span>-&nbsp;Please let us know about yourself so we can keep in touch about future job openings!<br /><br /><strong><span class="">NURSE&nbsp;RECRUITMENT&nbsp;HOTLINE:</span>&nbsp;<span class="">718-920-6697 (</span><span class="">Monday-Friday: 9am-4pm)&nbsp;&nbsp;</span></strong><br /><br /><strong>Check Out Our Employee&nbsp;<span style="text-decoration: underline;"><a href="https://healthymebenefits.com/" target="_blank" title="Benefits" rel="noopener noreferrer">Benefits</a></span></strong></h4> <h4 class="p1"><span style="text-decoration: underline;"><strong><a href="https://s3.us-east-1.amazonaws.com/vizi.vizirecruiter.com/MontefioreHealthSystem+RecruitingPractices.pdf" target="_blank" title="Safe Online Recruiting" rel="noopener noreferrer">Our Commitment to Safe Online Recruiting</a></strong></span></h4> https://www.montefiore.org/

keywords: position summary,audit,compliance,documentation,analysis,coordinate,training,quality assurance,education & experience,skills

Full time

Overview: Safeguards Montefiore Medical Center revenue and reputation, through the following activities:
Responsibilities: <ul> <li>Participates in external government audits, including:<br /> <ul> <li>NY Office of Medicaid Inspector General (OMIG)</li> <li>Office of Inspector General (OIG)</li> <li>Medicaid Fraud Control Unit (MFCU)</li> <li>NY Attorney General (AG)</li> <li>NY Department of Health (DOH)</li> <li>Centers for Medicare and Medicaid Services (CMS)</li> <li>National Government Services (NGS)</li> <li>Medicaid Integrity Program Contractor (MIC)</li> <li>Recovery Audit Contractor (RAC)</li> <li>Zone Program Integrity Contractor (ZPIC)</li> <li>Health Care Fraud Prevention and Enforcement Action Team (HEAT)</li> <li>Ensure timely and accurate response to external audit, in order to mitigate Medical Center risk (financial and reputational) imposed by regulatory agencies.</li> <li>Tracking of final audit result (repayment amount) versus initial audit repayment request)</li> </ul> </li> <li>Coordinates, supervises, and performs medical record audits of documentation, coding and billing for technical and professional services, including:<br /> <ul> <li>CPT</li> <li>ICD9</li> <li>HCPCII</li> <li>DRG</li> <li>APC</li> <li>APG</li> <li>Modifiers</li> <li>Teaching Physician Guidelines</li> <li>Non-Physician Practitioner Documentation ( including &ldquo;incident-to&rdquo; guidelines)</li> <li>Ensuring MMC employees understand and comply with rules and regulations. Mitigating risk of audits, corporate integrity agreements, fines etc. imposed by regulatory agencies. Avoid repetitive deficiencies in establishing process</li> <li>Monitor level of compliance/adherence to rules and regulations on the federal, state, and local level through regular and ongoing audit activities.</li> </ul> </li> <li>Conducts audits of electronic and manual documentation, coding, and billing systems.<br /> <ul> <li>Ensuring MMC employees understand and comply with rules and regulations. Mitigating risk of audits, corporate integrity agreements, fines etc. imposed by regulatory agencies</li> <li>Monitor level of compliance/adherence to rules and regulations on the federal, state, and local level through regular and ongoing audit activities.</li> </ul> </li> <li>Communicates with external agencies regarding audits.<br />Participates in development of voluntary disclosures and repayments to federal and state agencies.<br /> <ul> <li>Ensure timely and accurate response to external audit, in order to mitigate Medical Center risk (financial and reputational) imposed by regulatory agencies.</li> <li>Tracking of final audit result (repayment amount) versus initial audit repayment request).</li> </ul> </li> <li>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.<br /> <ul> <li>Ensuring transparency of findings and communications. Implementation of corrective action and education as appropriate.</li> <li>Monitor level of compliance/adherence to rules and regulations on the federal, state, and local level through regular and ongoing audit activities.</li> </ul> </li> <li>Conducts close-out meetings with senior management of applicable department.<br />Coordinates audit activities with Internal Audit, as necessary.<br />Identifies compliance risk areas and develops action plans accordingly.<br /> <ul> <li>Ensuring transparency of findings and communications. Implementation of corrective action and education as appropriate.</li> <li>Monitor level of compliance/adherence to rules and regulations on the federal, state, and local level through regular and ongoing audit activities.</li> </ul> </li> <li>Develops and coordinates analysis of encounter forms and documentation templates.<br /> <ul> <li>Ensuring all encounter forms are accurate and up to date.</li> <li>Ensuring documentation templates are in compliance with established rules and regulations.</li> <li>Review of updated forms.</li> </ul> </li> <li>Audits and enforces compliance policies and procedures.<br /> <ul> <li>Ensuring all policies and procedures are accurate, up to date, and in compliance with established rules and regulations.</li> <li>Review of updated policies and procedures.</li> </ul> </li> <li>Develops and conducts documentation, coding and billing curriculum and education classes for 500+ physicians, allied health professionals, and coding and billing associates annually, including:<br /> <ul> <li>One-on-one education sessions based on audit findings</li> <li>Topic-specific group education</li> <li>Mandatory Compliance education</li> <li>Compliance Monthly education calendar sessions</li> <li>Grand Rounds</li> <li>Monthly Faculty Meetings</li> <li>Ensuring that the Medical Center has documented evidence of its commitment to compliance and training. Ensuring that training occurs frequently and ongoing, as mandated by NY OMIG.</li> <li>Tracking of attendees in compliance training database.</li> </ul> </li> <li>Assists with distribution of all Medicare and DOH updates and code changes to the appropriate associates.<br />Facilitates responses to compliance-related inquiries (phone, e-mail, in-person).<br /> <ul> <li>Ensuring that the Medical Center has documented evidence of its commitment to compliance and training. Ensuring that training occurs frequently and ongoing, as mandated.</li> <li>Increased associate awareness of rules and regulations.</li> </ul> </li> </ul>
Requirements: <ul> <li>Bachelor's Degree Required.</li> <li>Minimum 5 years of Billing, Coding, and Documentation experience in a hospital setting Required.</li> <li>Coding certification (such as CCS, CPC, RHIA, RHIT) Required.</li> <li>Needs to be familiar with both facility and professional documentation, coding and billing rules and regulations.</li> <li>Needs to be able to navigate registration, billing, and documentation systems with ease.</li> <li>Knowledge of local, state, and federals rules and regulations.</li> <li>Able to communicate with all level associates, including senior management and external agencies.</li> <li>Excellent written and oral communication skills.</li> <li>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.</li> </ul>