Sr Physician Compliance Auditor

Facility: CHS Services
Location: Farmingdale, NY
Department: Internal Audit & Compliance
Category: Administrative / Business Support
Schedule: Full Time
Shift: Day shift
Hours: 8 am – 5 pm
ReqNum: 6030745

At Catholic Health, we are more than 18,000 professionals inspired by innovation, strengthened by compassion, and driven to excellence. From working with a team of world-class healthcare professionals to state-of-the-art facilities, you’ll have everything you need to do something incredible–for yourself, and for the community we serve.

Join our team and discover why Catholic Health was named Long Island’s Top Workplace.

The Senior Physician Compliance Auditor shall be primarily concerned with performing reviews to determine the accuracy of inpatient and outpatient physician coding for Catholic Health Services of Long Island and its System Affiliates (collectively CHS).

Responsibilities

• Understand and maintain strict professional confidentiality of patient information, work plans and projects.
• Maintain abreast of compliance issues related to the healthcare industry, annual coding updates and frequent regulatory changes.
• Exercise due professional care in performing compliance reviews.
• Possess the knowledge, skills and disciplines essential to the performance of compliance reviews.
• Coordinate and perform educational training programs consisting of appropriate documentation guidelines and accurate coding to all appropriate personnel, including coding staff, physicians, billing personnel and ancillary departments.
• Conduct regular audits and coordinate the monitoring of coding and documentation accuracy.
• When necessary, assist in the implementation of corrective action plans, such as educational programs, to prevent similar denials and rejections from recurring.
• Determine the scope, objectives and approach of each review to be performed.
• Prepare compliance review plans with emphasis on clearly describing the various auditing procedures to be used and the key points in the area to which they will be applied.
• Collect, analyze, interpret and document information to support audit findings.
• Prepare audit reports to document area under review, procedures performed and conclusions met.
• Perform oral presentations to all levels of management throughout the review, discussing review objectives and approach, deficiencies found (if any), and recommendations for improvement.
• Appraise adequacy of management’s response to recommendations cited in oral and written reports.
• Provide individualized feedback and information to providers as it relates to the compliance audits being performed.
• Conduct annual audits as it relates to the Office of the Inspector General (OIG) and Office of the Medicaid Inspector General (OMIG) work plans to ensure adherence with Federal and State guidelines.
• Perform annual review of physician charge tickets to ensure compliance with annual coding updates.
• Report noncompliance issues detected through auditing and monitoring, nature of corrective action plans, and results of follow-up audits to the compliance management team
• Serve as a resource for department managers, staff, physicians and administration to obtain information on accurate and ethical coding and documentation standards, guidelines and regulatory requirements.
• Obtain access to technologies and other resources which provide up to date releases on changes in laws, rules and regulations.
• Provide research and support for special projects within CHS.

Requirements

• Bachelor degree preferred. A minimum of five years physician office, billing or auditing experience may be substituted in lieu of a degree.
• CPC or CCS-P certification required. Position requires six months of on the-the job training is required to become familiar with organizational policies and procedures.
• Shall possess the knowledge, skills and disciplines essential to the performance of physician compliance reviews of healthcare institutions, as follows:
• A strong knowledge base in complete and accurate clinical documentation.
• A strong knowledge of Federal and State health care regulations, standards, policies and requirements pertaining to documentation, coding and billing.
• The ability to accurately interpret and implement regulatory standards and legal requirements.
• Strong analytical and problem-solving skills and have expertise in report writing and oral communications.
• Strong professional attitude and have the ability to work with and communicate effectively with all levels of management and personnel.

At Catholic Health your well-being comes first, with comprehensive compensation and benefits; our offerings go beyond the basics. In addition to multiple medical plans, life insurance, generous paid time off and flexible spending accounts, we also offer substantial tuition reimbursement, an employer funded pension plan and several savings plan options for your future.