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* 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 recommendations, which are presented to senior management of applicable department, the Executive Compliance Committee and the Board of Trustees. \* Ensuring transparency of findings and communications. Implementation of corrective action and education as appropriate \* Monitor level of compliance/adherence to rules and regulations on the federal, state, and local level through regular and ongoing audit activities.* 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. \* Ensuring transparency of findings and communications. Implementation of corrective action and education as appropriate \* Monitor level of compliance/adherence to rules and regulations on the federal, state, and local level through regular and ongoing audit activities.* Develops and coordinates analysis of encounter forms and documentation templates \* Ensuring all encounter forms are accurate and up to date. \* Ensuring documentation templates are in compliance with established rules and regulations. \* Review of updated forms* Audits and enforces compliance policies and procedures. \* Ensuring all policies and procedures are accurate, up to date, and in compliance with established rules and regulations. \* Review of updated 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 \* 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. \* Tracking of attendees in compliance training database.* 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). \* Ensuring that the Medical Center has documented evidence of its commitment to compliance and training. Ensuring that training occurs frequently and ongoing, as mandated. \* Increased associate awareness of rules and regulations**Qualifications*** Bachelor Degree Required* Minimum 5 Years of Billing, Coding, and Documentation experience in a hospital setting Required* #J-18808-Ljbffr Montefiore Orthopedics