Regulatory Affairs Associate - Tarrytown

Job Description:

ENT and Allergy Associates, LLP and Hümi is seeking a self-motivated, people-friendly full time Regulatory Affairs Associate for our Tarrytown Corporate office location.

Salary: $80,000-$85,000/year

The Compliance Auditor and Coder supports the organization’s Compliance Program by conducting risk-based medical record, coding, billing, and documentation audits for professional services. This role evaluates the accuracy and completeness of CPT, ICD-10-CM, HCPCS Level II, and modifier assignment; assesses compliance with applicable federal and state requirements, payer guidance, internal policies, and documentation standards; and identifies opportunities to reduce coding risk, prevent fraud, waste, and abuse, and strengthen revenue integrity.

The position also serves as a coding and documentation resource to providers, staff, and management and supports education, corrective action, and follow-up monitoring.

Audit priorities may be driven by internal risk assessments, federal and state work plans, payer activity, regulatory guidance, industry alerts, data analytics, external reviews, or management requests.

Essential Responsibilities Coding, Documentation & Billing Audits
· Conduct prospective and retrospective audits of medical records and claims to evaluate documentation completeness, medical coding accuracy, modifier use, billing practices, and the timeliness of documentation.
· Validate CPT, ICD-10-CM, HCPCS Level II, Evaluation and Management (E/M), and other applicable professional coding assignments against the medical record and relevant guidance.
· Identify over coding, under coding, unsupported services, documentation gaps, modifier concerns, and other compliance or reimbursement risks.
· Analyze audit findings for trends, patterns, variances, root causes, and potential areas of organizational risk.
· Prepare clear, accurate, and actionable audit reports that summarize methodology, findings, risk, and recommended corrective actions.
· Perform follow-up audits to evaluate the effectiveness and sustainability of corrective action plans and document outcomes for management.
· Collaborate with Compliance, Revenue Cycle, Clinical Operations, and other stakeholders on audits, investigations, and special projects as assigned.

Compliance & Regulatory Support
· Support the administration, monitoring, and continuous improvement of the organization’s Compliance Program and compliance work plan.
· Research coding, billing, documentation, and reimbursement requirements and communicate relevant regulatory or payer changes to appropriate stakeholders.
· Serve as a resource to providers, employees, and management on coding, documentation, billing, and related compliance policies and procedures.
· Assist in identifying the need for new or revised policies, procedures, controls, and education based on audit results, regulatory changes, and emerging risks.
· Assist with responses to external audits, medical record requests, and payer or government reviews, including record collection, documentation analysis, and appeal support, as appropriate.
· Review identified refunds or over payments related to audit or committee activity to verify appropriate processing and closure.
· Assist with compliance-related coding edits, rules, or other monitoring tools as assigned.

Education & Provider Support
· Develop audit-based educational materials and practical coding/documentation guidance for providers and staff.
· Participate in individual and group education, including remedial education when audit findings indicate a need for corrective action.
· Communicate complex coding and compliance requirements in a clear, professional, and constructive manner.
· Maintain current professional knowledge through continuing…