Compliance Billing and Coding Auditor, Senior

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

Safeguards Montefiore Medical Center revenue and reputation, through the following activities:

NY Office of Medicaid Inspector General (OMIG)

Office of Inspector General (OIG)

Medicaid Fraud Control Unit (MFCU)

Centers for Medicare and Medicaid Services (CMS)

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.

Coordinates, supervises, and performs medical record audits of documentation, coding and billing for technical and professional services, including:

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.

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

Mandatory Compliance education

Compliance Monthly education calendar sessions

Assists in development and distribution of MediRegs risk assessments to various departments to determine inclusion in annual work plan.

Facilitates responses to compliance-related inquiries (phone, e-mail, in-person).

Bachelor Degree Required

Minimum 5 Years of Billing, Coding, and Documentation experience in a hospital setting Required

Coding certification (such as CCS, CPC, RHIA, RHIT)/ability to obtain within one year of hire Required.

Needs to be familiar with both facility and professional documentation, coding and billing rules and regulations.

Needs to be able to navigate registration, billing, and documentation systems with ease.

Knowledge of local, state, and federals rules and regulations.