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: $81,600.00-$

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 Medi Regs 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).

• 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…