Senior Compliance Specialist

Job Description

NYU Langone Health is a fully integrated health system that consistently achieves the best patient outcomes through a rigorous focus on quality that has resulted in some of the lowest mortality rates in the nation. Vizient Inc. has ranked NYU Langone the No. 1 comprehensive academic medical center in the country for three years in a row, and U.S. News & World Report recently placed nine of its clinical specialties among the top five in the nation.

NYU Langone offers a comprehensive range of medical services with one high standard of care across 6 inpatient locations, its Perlmutter Cancer Center, and over 320 outpatient locations in the New York area and Florida. With $14.2 billion in revenue this year, the system also includes two tuition-free medical schools, in Manhattan and on Long Island, and a vast research enterprise with over $1 billion in active awards from the National Institutes of Health.

For more information, go to NYU Langone Health, and interact with us on Linked In, Glassdoor, Indeed, Facebook, Twitter, You Tube and Instagram.

Position Summary:
We have an exciting opportunity to join our team as a Senior Compliance Specialist.

The Senior Compliance Specialist (Hospital Billing Auditor) will support the Manager of Hospital Billing Compliance and the Director of Billing Compliance in the development and implementation of the Hospital Billing Compliance program at NYU Langone Health System to ensure adherence with federal and state billing regulations. Primary responsibilities include conducting audits to determine organizational integrity of billing facility and technical hospital fees, including identifying areas requiring improvement, and providing recommendations and education to providers and staff.

Job Responsibilities:

• Assists with management of the comprehensive Hospital Billing Compliance workplan to ensure that billing and coding of hospital services are in accordance with federal, state, local and managed care payor regulations.
• Conducts risk assessments to define audit priorities by evaluating previous audit findings, management priorities, ICD, APC and DRG utilization patterns, national normative data, CMS and PEPPER initiatives, OIG work plans and advisories, and healthcare industry best practices.
• Conducts Hospital Compliance audits consisting of evaluation of adequacy and accuracy of documentation in support of services billed, including ICD/CPT/HCPCS and other third-party payor codes, DRG assignment, APC code assignment, medical necessity of services, and compliance with other documentation, coding and billing standards.
• Adheres to audit timeline and audit protocol standards; assists with development of audit schedules.
• Prepares written reports of audit findings and recommendations and presents the findings to leadership of the respective department, coding staff, Health Information Management staff and others as appropriate; evaluates the adequacy of management action plan, as needed, to improve deficiencies.
• Evaluates the adequacy and effectiveness of internal and operational controls designed to ensure that processes and practices lead to appropriate execution of regulatory requirements and guidelines related to facility and technical fee documentation, coding and billing, including federal and state regulations and guidelines, CMS and other third-party payor billing rules, and OIG/OMIG compliance standards.
• Develops a comprehensive education program to train department managers, staff and physicians in all areas of compliance and billing requirements. Provides information which is clear and coherent. Prepares presentations and develops training materials as needed.
• Assists Compliance Department management with federal, state and other special investigations and audits.
• Effectively maintains collaborative working relationships with department leadership and Revenue Cycle Operations management team to provide education on improvements in billing and documentation practices.
• Serves as subject matter expert and authoritative resource on interpretation and application of documentation and coding rules and regulations and medical necessity of services…