Senior
Montefiore Health System, Inc. · Bronx, New York
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Perform and lead medical record, coding and billing compliance audits and report findings to senior management.
Worth knowing: Will audit and respond to numerous federal and state government agencies
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: Job Summary 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 HCPCII 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, which are presented to senior management of applicable department, the Executive Compliance Committee and the Board of Trustees. • Conducts close-out meetings with senior management of applicable department. • 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.
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