NYU Langone Health is a world-class, patient-centered, integrated academic medical center, known for its excellence in clinical care, research, and education. It comprises more than 200 locations throughout the New York area, including five inpatient locations, a children's hospital, three emergency rooms and a level 1 trauma center. Also part of NYU Langone Health is the Laura and Isaac Perlmutter Cancer Center, a National Cancer Institute designated comprehensive cancer center, and NYU Grossman School of Medicine, which since 1841 has trained thousands of physicians and scientists who have helped to shape the course of medical history. At NYU Langone Health, equity, diversity, and inclusion are fundamental values. We strive to be a place where our exceptionally talented faculty, staff, and students of all identities can thrive. We embrace diversity, inclusion, and individual skills, ideas, and knowledge. For more information, go to nyulangone.org , a nd interact with us on LinkedIn , Glassdoor , Indeed , __Facebook , Twitter , YouTube and Instagram .
Position Summary:
We have an exciting opportunity to join our team as a Senior Compliance Specialist (Hospital).
In this role, the successful Senior Compliance Specialist will support the Manager of Hospital Billing Compliance and the Director of Billing Compliance in the development and implementation of the Hospital Billing Compliance program at NYU Langone Health System, to ensure adherence with federal and state billing regulations. Primary responsibilities include conducting audits to determine organizational integrity of billing facility and technical hospital fees including identifying areas requiring improvement and providing recommendations and education to providers and staff.
Job Responsibilities:
1. Assists with management of the comprehensive Hospital Billing Compliance workplan to ensure that billing and coding of hospital services are in accordance with federal state local and managed care payor regulations
2. Conducts risk assessments to define audit priorities by evaluating previous audit findings management priorities ICD APC and DRG utilization patterns national normative data CMS and PEPPER initiatives OIG work plans and advisories and healthcare industry best practices
3. Conducts Hospital Compliance audits consisting of evaluation of adequacy and accuracy of documentation in support of services billed including ICD/CPT/HCPCS and other third party payor codes DRG assignment APC code assignment medical necessity of services and compliance with other documentation coding and billing standards
4. Adheres to audit timeline and audit protocol standards; assists with development of audit schedules
5. Prepares written reports of audit findings and recommendations and presents the findings to leadership of the respective department coding staff Health Information Management staff and others as appropriate; evaluates the adequacy of management action plan as needed to improve deficiencies
6. Evaluates the adequacy and effectiveness of internal and operational controls designed to ensure that processes and practices lead to appropriate execution of regulatory requirements and guidelines related to facility and technical fee documentation coding and billing including federal and state regulations and guidelines CMS and other third party payor billing rules and OIG/OMIG compliance standards
7. Develops a comprehensive education program to train department managers staff and physicians in all areas of compliance and billing requirements Provides information which is clear and coherent Prepares presentations and develops training materials as needed
8. Assists Compliance Department management with federal state and other special investigations and audits
9. Effectively maintains collaborative working relationships with department leadership and Revenue Cycle Operations management team to provide education on improvements in billing and documentation practices
10. Serves as subject matter expert and authoritative resource on interpretation and application of documentation and coding rules and regulations and medical necessity of services delivered
11. Annually identifies specific needs for self development and implements a plan to achieve professional growth
12. Maintains privacy of patient information and confidentiality of compliance information and activities
13. Assists in any special projects and/or internal or external federal or state agency inquiries and performs and participates in other related duties as required
Minimum Qualifications:
Preferred Qualifications:
Bachelors degree in Nursing or Masters degree in Nursing Hospital Billing experience in a large academic health care setting 4 5 years of experience in facility fee auditing/coding or medical necessity reviews or related work Ability to understand and interpret medical records hospital bills and the charge master as well as an understanding of all ancillary department functions Holds one of the following coding certifications: MPG Certified Inpatient Coder CIC AHIMA Certified Coding Specialist CCS or AHIMA Certified Coding Associate CCA Proficiency in payment review systems hospital information systems and clinical record information systems Knowledge of regulatory agencies requirements CMS NYS Medicaid OIG and OMIG Strong quantitative analytical communication and interpersonal skills and ability to work collaboratively with team members and others
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 and 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.
If you wish to view NYU Langone Health's EEO policies, please click here. Please click here to view the Federal "EEO is the law" poster or visit https://www.dol.gov/ofccp/regs/compliance/posters/ofccpost.htm for more information.
NYU Langone Health provides a salary range to comply with the New York state Law on Salary Transparency in Job Advertisements. The salary range for the role is $81,325.15 - $128,272.72 Annually. Actual salaries depend on a variety of factors, including experience, specialty, education, and hospital need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.
To view the Pay Transparency Notice, please click here
Required Skills
Required Experience