Northwell Health Manager, Compliance Audit in Great Neck, New York

Req Number 001UR2

Job Category Legal/Corporate Compliance/Risk Management

Job Description

As a Compliance Audit Manager you will manage, plan, organize and evaluate the staff and activities associated with Compliance Audit including, but not limited to identifying areas of compliance risk and executing the annual audit work plan related to health system facilities and faculty.

Responsibilities Include:

  • Manages daily operations, staff and external (contract) audit teams in accordance with audit work plans.

  • Completes audit planning and implements compliance audits, independently.

  • Manages Corporate Compliance audits and reports findings.

  • Identifies risks and notifies senior compliance management.

  • Develops, implements, tracks and reports on work plans for correction and adherence to policies and standards.

  • Reviews audit work papers including, but not limited to billing claims detail, coding and medical record documentation to determine compliance with appropriate CPT and state and federal regulations and guidelines.

  • Researches, interprets and communicates federal and state laws and guidelines pertaining to Medicare and New York State Medicaid to audit report owners.

  • Leads and facilitates teams to accomplish changes in the Health System which support compliant documentation, billing and coding of services provided.

  • Manages billing data analysis projects resulting in identification of potential compliance related risks.

  • Creates annual Compliance Risk Assessment and Audit Work Plan documents.

Qualifications

  • Bachelor’s Degree in a health related field, required.

  • Minimum of five (5) years experience including hospital coding and supervisory/leadership, required. Experience in a large academic health system environment, preferred.

  • Certification, Healthcare Compliance (CHC), required.

  • Coding certification - Certified Coding Specialist (CCS), Certified Coding Specialist - Physician-based (CCS-P) or Certified Professional Coder (CPC), required. CCS, preferred.

  • Current knowledge of changes in coding and reimbursement, required.

  • Current knowledge of regulatory requirements, hospital and physician practice guidelines as established by all applicable regulatory bodies.

  • Strong conceptual, analytical, communication and interpersonal skills required.

  • Ability to work independently, lead staff, solve problems and communicate effectively with all levels of staff.

  • Ability to read and interpret regulations and implement appropriate risk assessment methodologies and audits.

  • Proficiency in Microsoft Office applications, required.

  • Knowledge of IDX, Eclipsys and/or Siemens Clinical Systems preferred.

Our Culture

Transforming care, optimizing patient satisfaction and creating better patient outcomes are just some of the things our talented team members are doing at North Shore-LIJ each and every day. As a culture committed to providing our customers with the highest quality service, we stand behind our core values: Patients first; Caring; Excellence; Innovation; Integrity and Teamwork. It is our commitment and our culture that sets us apart from others and is the cornerstone of everything we do. Join an organization whose team members are valued, cared for and offered continuous opportunities to grow. Click on the link to learn more about us: www.northshorelij.com/goals

Please note: North Shore-LIJ is a smoke-free environment. Smoking and the use of tobacco products is strictly prohibited anywhere on campus, including parking lots and outdoor areas on the premises. Free smoking cessation programs and quit medications are offered to team members who wish to quit through the North Shore-LIJ Center for Tobacco Control.