Compliance Medical Auditor - Hiring Fast

We are looking to hire a competitive Compliance Medical Auditor to join our awesome team at SB Clinical Practice Management Plan in New York State.
Growing your career as a Full Time Compliance Medical Auditor is an incredible opportunity to develop competitive skills.
If you are strong in planning, teamwork and have the right initiative for the job, then apply for the position of Compliance Medical Auditor at SB Clinical Practice Management Plan today!

Compliance Medical Auditor - Stony Brook CPMP Compliance

Location: St. James, NY ( At the manager’s discretion, this role may be eligible for hybrid remote work; this position is only available to New York State Residents) 

Schedule: Full Time

Days/Hours: Monday through Friday - 8:00am to 4:30pm

Salary Range: $67,034 - $81,221 (pay will be determined based on experience, preferred qualifications, and education)

Our compensation philosophy aims to provide marketable compensation programs and to compensate employees based on relevant experience and education. Individual compensation discussions begin during the hiring process and may occur during job review and promotional opportunities. Salaries vary depending on experience, education and current market for the position. Human Resources determines the external and internal equitable salary for each employee. 

SUMMARY: The SB Clinical Practice Management Plan, Inc. (CPMP) Compliance Medical Auditor supports the functions of the Compliance Program for CPMP and its University Faculty Practice Corporations to be compliant with Federal and State guidelines in the prevention of fraud, waste, and abuse. The Compliance Medical Auditor will participate and provide duties such as but not limited to conducting auditing and monitoring; providing training and education; assessing compliance with policies, procedures, and regulations; and identifying and recommending strategies for process improvements. The Compliance Medical Auditor performs auditing and monitoring of clinical documentation, analyzing medical records, and assessing the accuracy of ICD-10-CM diagnosis code and CPT assignments; and determining compliance with Federal and State regulations and guidelines. These audits and other projects are identified considering risks identified in State and Federal work plans, industry communications, fraud alerts, regulatory agencies, data mining using software applications, or per management’s request.

 

Responsibilities and Duties:

• Conduct medical record documentation and coding/billing audits assessing the accuracy of CPT codes, diagnoses, and modifier assignments; determining compliance with appropriate policies, procedures, bylaws, clinical staff rules and regulations, and federal and state regulations, and the timeliness of documentation.
• Collaborate with colleagues on audits and projects as needed. Produce high-quality work that is competently and efficiently performed in accordance with department standards. Monitor to identify patterns, trends, and variances during and from audits.
• Develop reports from the audit results and/or other sources and assess the need for further review or intervention.
• Participate in the preparation and delivery of compliance education and training programs and remedial education with Providers.
• Conduct follow-up audits as indicated to appraise the adequacy of corrective actions and determine whether deficiencies are corrected; prepare the appropriate reports for management.
• Serve as a coding, documentation, and policy and procedure resource providing regulatory guidance to Providers, employees, and management.
• Research relevant regulations and communicate the need for policies and procedures and education.
• Maintain a current working knowledge on regulatory requirements associated with professional coding, billing, documentation, and reporting requirements in an academic medical center and in hospital clinics and physician offices.
• Seek ongoing training and development to gain additional expertise in fulfilling the elements of an effective compliance program.
• Maintain professional skills and knowledge through attendance at relevant educational programs, participation in professional organizations and applicable webinars, and by reviewing current literature.
• Other projects as assigned.

Required Qualifications:

• Associate’s Degree with two years of experience performing professional coding or conducting coding, documentation, and billing audits of professional claims. Must have a current coding certification through the American Academy Professional Coders (AAPC) or the American Health Information Management Association (AHIMA).
• In lieu of Associate’s Degree, graduation from a medical billing and coding program with three years of experience performing professional coding or conducting coding, documentation, and billing audits of professional claims. Must have a current membership with AAPC or AHIMA and be willing to obtain certification within six months of hire OR graduation from a medical billing and coding program with four years of experience performing professional coding or conducting coding, documentation, and billing audits of professional claims. Must have a current coding certification through the American Academy Professional Coders (AAPC) or the American Health Information Management Association (AHIMA)
• Ability to work collaboratively with physicians, non-physician practitioners, staff and leaders of clinical, financial, and other departments.

 

Preferred Qualifications:

• Bachelors' Degree.
• Experience with IDX and Cerner.
• Experience using MD audit software.
• Prior experience within an academic healthcare hybrid entity.

 

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to perform the essential functions of this job successfully. While performing the duties of this job, the employee is regularly required to communicate with patients, staff, and medical providers. The employee must be able to exchange accurate information in these situations. This position is active and requires the employee to constantly move about in the office to assist patients, staff, and medical providers. Any additional physical demands will be outlined and provided by management.

 

The responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of CPMP.

 

CPMP provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, gender identity or expression, or any other legally protected status. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall and transfer, leaves of absence, compensation, and training.

 

CPMP expressly prohibits any form of workplace harassment based on race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, gender identity, or any other legally protected status. Improper interference with the ability of CPMP’s employees to perform their job duties may result in discipline up to and including discharge.

Benefits of working as a Compliance Medical Auditor in New York State:

● Company offers great benefits
● Opportunities to grow
● Competitive salary

● Remote Work opportunity