Position Summary: We have an exciting opportunity to join our team as a Clin Doc Compliance Specialist.
In this role, the successful candidate The Senior Compliance Specialist with assist the Associate Director Hospital Compliance in conducting reviews of inpatient and outpatient coding, billing, and documentation in accordance with Federal, state and local regulations. Responsibilities include drafting written reports on audit findings, assisting on internal investigations, and providing in-service training to physicians and staff.
Responsible for conducting audits of medical records to determine whether services provided to patients are appropriately documented and billed in accordance with Medicare, Medicaid and third party billing regulations and/or standards..
Assists Associate Director in investigating inquires which may relate to erroneous billing and coding of services.
Works closely with Internal Audit, FGP Compliance, Health Information Management and Patient Financial Services to conduct coding reviews and inquires.
Drafts written reports that summarize medical record review findings for Director review.
Provides in-services and educational materials on subjects pertinent to reviews conducted, and any coding and billing changes to appropriate NYULMC staff.
Determines whether medical necessary criteria are met as required by CMS and the fiscal intermediary through Nation coverage Decision (NCDS), Local Coverage Determinations and other guidance in effect at the time of review.
Summarizes monthly activity status on the dashboard report.
Contributes to or writes articles for the Hospital Compliance Newsletter.
Reviews areas of focus designated by the Recovery Auditors contractors, MIC, OIG, OMIG and other regulatory agencies.
Generate reports from hospital information systems such as Epic Account Query, Epic Business Objects, and EPSI data to assist in hospital reviews.
Keep abreast of ICD-9-CM, ICD-10, CPT-4 and HCPCS coding changes, compliance issues and regulations and provides communication and updates regarding changes in regulations, policies or procedures pertaining to the Compliance Program.
Performs and participates in other related duties as required.
Minimum Qualifications: To qualify you must have a Bachelor's Degree in Finance, Healthcare administration or related fieldMinimum of 4 years of hospital coding and billing experience. Certification in clinical coding is requiredStrong problem solving and analytical skills. Excellent verbal and written communication skills. Proficiency in Microsoft office. Must be able to communicate with physicians, senior administrators and office staff.
Preferred Qualifications: Bachelors degree in Nursing, and a minimum of 4 years nursing and healthcare related experience.> Masters degree> EPIC systems and/or EHR experience.
Qualified candidates must be able to effectively communicate with all levels of the organization.
NYU Langone Health provides its staff with far more than just a place to work. Rather, we are an institution you can be proud of, an institution where you'll feel good about devoting your time and your talents.
NYU Langone Health is an equal opportunity and affirmative action employer committed to diversity and inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, gender, gender identity or expression, sex, sexual orientation, transgender status, gender dysphoria, national origin, age, religion, disability, military or veteran status, marital or parental status, citizenship status, genetic information or any other factor which cannot lawfully be used as a basis for an employment decision. We require applications to be completed online.
NYU Langone Health, a world-class patient-centered integrated academic medical center, is one of the nation's premier centers for excellence in clinical care, biomedical research, and medical education. Located in the heart of Manhattan, NYU Langone is composed of four hospitals – Tisch Hospital, its flagship acute care facility; Rusk Rehabilitation; the Hospital for Joint Diseases, one of only five hospitals in the nation dedicated to orthopaedics and rheumatology; and Hassenfeld Children's Hospital, a comprehensive pediatric hospital supporting a full array of children's health services across the medical center – plus the NYU School of Medicine, which since 1841 has trained thousands of physicians and scientists who have helped to shape the course of medical history. The medical center's tri-fold mission to serve, teach, and discover is achieved 365 days a year through the seamless integration of a culture devoted to excellence in patient care, education and research. For more information, go to www.nyulangone.org.