Manager Recovery Audit Contractor Jobs (NOW HIRING)

IntroductionTo heal, to teach, to discover and to advance the health of the communities we serve.

To learn more about the “Montefiore Difference” – who we are at Montefiore and all that we have to offer our associates, please click here. 

OverviewSafeguards Montefiore Medical Center revenue and reputation, through the following activities:

Responsibilities

• 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)
  • Ensure timely and accurate response to external audit, in order to mitigate Medical Center risk (financial and reputational) imposed by regulatory agencies.
  • Tracking of final audit result (repayment amount) versus initial audit repayment request)
• 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)
  • Ensuring MMC employees understand and comply with rules and regulations. Mitigating risk of audits, corporate integrity agreements, fines etc. imposed by regulatory agencies. Avoid repetitive deficiencies in establishing process
  • Monitor level of compliance/adherence to rules and regulations on the federal, state, and local level through regular and ongoing audit activities.
• Conducts audits of electronic and manual documentation, coding, and billing systems.
  
  • Ensuring MMC employees understand and comply with rules and regulations. Mitigating risk of audits, corporate integrity agreements, fines etc. imposed by regulatory agencies
  • Monitor level of compliance/adherence to rules and regulations on the federal, state, and local level through regular and ongoing audit activities.
• Communicates with external agencies regarding audits.
  Participates in development of voluntary disclosures and repayments to federal and state agencies.
  
  • Ensure timely and accurate response to external audit, in order to mitigate Medical Center risk (financial and reputational) imposed by regulatory agencies.
  • Tracking of final audit result (repayment amount) versus initial audit repayment request).
• 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.
  
  • Ensuring transparency of findings and communications. Implementation of corrective action and education as appropriate.
  • Monitor level of compliance/adherence to rules and regulations on the federal, state, and local level through regular and ongoing audit activities.
• 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.
  
  • Ensuring transparency of findings and communications. Implementation of corrective action and education as appropriate.
  • Monitor level of compliance/adherence to rules and regulations on the federal, state, and local level through regular and ongoing audit activities.
• Develops and coordinates analysis of encounter forms and documentation templates.
  
  • Ensuring all encounter forms are accurate and up to date.
  • Ensuring documentation templates are in compliance with established rules and regulations.
  • Review of updated forms.
• Audits and enforces compliance policies and procedures.
  
  • Ensuring all policies and procedures are accurate, up to date, and in compliance with established rules and regulations.
  • Review of updated policies and procedures.
• Develops and conducts documentation, coding and billing curriculum and education classes for 500+ physicians, allied health professionals, and coding and billing associates annually, including:
  
  • One-on-one education sessions based on audit findings
  • Topic-specific group education
  • Mandatory Compliance education
  • Compliance Monthly education calendar sessions
  • Grand Rounds
  • Monthly Faculty Meetings
  • Ensuring that the Medical Center has documented evidence of its commitment to compliance and training. Ensuring that training occurs frequently and ongoing, as mandated by NY OMIG.
  • Tracking of attendees in compliance training database.
• Assists with distribution of all Medicare and DOH updates and code changes to the appropriate associates.
  Facilitates responses to compliance-related inquiries (phone, e-mail, in-person).
  
  • Ensuring that the Medical Center has documented evidence of its commitment to compliance and training. Ensuring that training occurs frequently and ongoing, as mandated.
  • Increased associate awareness of rules and regulations.

Requirements

• Bachelor's Degree Required.
• Minimum 5 years of Billing, Coding, and Documentation experience in a hospital setting Required.
• Coding certification (such as CCS, CPC, RHIA, RHIT) Required.
• Needs to be familiar with both facility and professional documentation, coding and billing rules and regulations.
• Needs to be able to navigate registration, billing, and documentation systems with ease.
• Knowledge of local, state, and federals rules and regulations.
• Able to communicate with all level associates, including senior management and external agencies.
• Excellent written and oral communication skills.
• Highly organized and analytical individual needs to be able to function with a high level of independence, motivate and train associates while maintaining good working relationships.