Senior Compliance Auditor

Benefits

Additional Information

City/State: Bronx, New York Grant Funded: No Department: Compliance - Education And Audits Work Shift: Day Work Days: MON-FRI Scheduled Hours: 8:30 AM-5 PM Scheduled Daily Hours: 7.5 HOURS Pay Range: $81,600.00-$102,000.00 Job Summary 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). Essential Functions 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) * Ensure timely and accurate response to external audit, in order to mitigate Medical Center risk (financial and reputational) imposed by regulatory agencies. * Tracking of final audit result (repayment amount) versus initial audit repayment request) 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) * 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 * Monitor level of compliance/adherence to rules and regulations on the federal, state, and local level through regular and ongoing audit activities. Conducts audits of electronic and manual documentation, coding, and billing systems. * Ensuring MMC employees understand and comply with rules and regulations. Mitigating risk of audits, corporate integrity agreements, fines etc. imposed by regulatory agencies * Monitor level of compliance/adherence to rules and regulations on the federal, state, and local level through regular and ongoing audit activities. Communicates with external agencies regarding audits. Participates in development of voluntary disclosures and repayments to federal and state agencies. * Ensure timely and accurate response to external audit, in order to mitigate Medical Center risk (financial and reputational) imposed by regulatory agencies. * Tracking of final audit result (repayment amount) versus initial audit repayment request) Develops formal audit reports of findings and recommend