Senior Compliance Auditor

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 HCPC II 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, presented to senior management, the Executive Compliance Committee, and the Board of Trustees. Conducts close‑out meetings with senior management. Coordinates audit activities with Internal Audit as necessary. Identifies compliance risk areas and develops action plans. 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 for inclusion in the 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) Ensures timely and accurate response to external audit to mitigate Medical Center risk and tracks final audit result versus initial request. Coordinates, supervises, and performs medical record audits of documentation, coding and billing for technical and professional services, including: CPT ICD9 HCPC II DRG APC APG Modifiers Teaching Physician Guidelines Non‑Physician Practitioner Documentation (including "incident‑to" guidelines) Monitors 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. Communicates with external agencies regarding audits and participates in development of voluntary disclosures and repayments. Develops formal audit reports of findings and recommendations for senior management, the Executive Compliance Committee, and the Board of Trustees. Conducts close‑out meetings with senior management. Coordinates audit activities with Internal Audit as necessary. 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 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). Qualifications Bachelor’s Degree required. Minimum five (5) years of Billing, Coding, and Documentation experience in a hospital setting required. Coding certification (such as CCS, CPC, RHIA, RHIT) or ability to obtain within one year of hire required. Familiar 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. Strong communication skills, able to interact with all levels of associates, including senior management and external agencies. Excellent written and oral communication skills. Highly organized and analytical, able to function independently, motivate and train associates while maintaining positive working relationships. Montefiore Health System, Inc. is an equal employment opportunity employer. Montefiore Health System, Inc. will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to 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. #J-18808-Ljbffr