Compliance Auditor and Coder Tarrytown

Job Description:

ENT and Allergy Associates LLP and Hümi is seeking a self-motivated people-friendly full time Compliance Auditor and Coder for our Tarrytown Corporate office location.

Salary: $80000-$85000/year

The Compliance Auditor and Coder supports the organizations Compliance Program by conducting risk-based medical record coding billing and documentation audits for professional services. This role evaluates the accuracy and completeness of CPT ICD-10-CM HCPCS Level II and modifier assignment; assesses compliance with applicable federal and state requirements payer guidance internal policies and documentation standards; and identifies opportunities to reduce coding risk prevent fraud waste and abuse and strengthen revenue integrity. The position also serves as a coding and documentation resource to providers staff and management and supports education corrective action and follow-up monitoring.

Audit priorities may be driven by internal risk assessments federal and state work plans payer activity regulatory guidance industry alerts data analytics external reviews or management requests.

Essential Responsibilities

Coding Documentation & Billing Audits

Conduct prospective and retrospective audits of medical records and claims to evaluate documentation completeness medical coding accuracy modifier use billing practices and the timeliness of documentation.

Validate CPT ICD-10-CM HCPCS Level II Evaluation and Management (E/M) and other applicable professional coding assignments against the medical record and relevant guidance.

Identify overcoding undercoding unsupported services documentation gaps modifier concerns and other compliance or reimbursement risks.

Analyze audit findings for trends patterns variances root causes and potential areas of organizational risk.

Prepare clear accurate and actionable audit reports that summarize methodology findings risk and recommended corrective actions.

Perform follow-up audits to evaluate the effectiveness and sustainability of corrective action plans and document outcomes for management.

Collaborate with Compliance Revenue Cycle Clinical Operations and other stakeholders on audits investigations and special projects as assigned.

Compliance & Regulatory Support

Support the administration monitoring and continuous improvement of the organizations Compliance Program and compliance work plan.

Research coding billing documentation and reimbursement requirements and communicate relevant regulatory or payer changes to appropriate stakeholders.

Serve as a resource to providers employees and management on coding documentation billing and related compliance policies and procedures.

Assist in identifying the need for new or revised policies procedures controls and education based on audit results regulatory changes and emerging risks.

Assist with responses to external audits medical record requests and payer or government reviews including record collection documentation analysis and appeal support as appropriate.

Review identified refunds or overpayments related to audit or committee activity to verify appropriate processing and closure.

Assist with compliance-related coding edits rules or other monitoring tools as assigned.

Education & Provider Support

Develop audit-based educational materials and practical coding/documentation guidance for providers and staff.

Participate in individual and group education including remedial education when audit findings indicate a need for corrective action.

Communicate complex coding and compliance requirements in a clear professional and constructive manner.

Maintain current professional knowledge through continuing education professional organizations webinars regulatory publications and industry resources.

Qualifications

Associate degree in health information management healthcare administration business or a related field required; bachelors degree preferred. Relevant experience may be considered in lieu of a degree where appropriate.

Minimum of two (2) years of professional coding auditing billing or related healthcare compliance experience required.

Current coding or auditing certification required such as CPC CCS CCS-P CPMA CEMC CENTC or an equivalent nationally recognized credential.

Compliance certification such as CHC or CPCO preferred.

Demonstrated knowledge of professional-fee coding documentation requirements third-party payer billing practices and applicable federal and state healthcare compliance requirements.

Working knowledge of Evaluation and Management (E/M) coding and documentation guidelines required.

ENT and/or Allergy specialty coding experience preferred.

Proficiency with Microsoft Excel Word and PowerPoint; experience with electronic health records practice management systems audit tools or data analytics applications preferred.

Core Competencies

High attention to detail sound judgment and strong analytical and critical-thinking skills.

Ability to interpret coding and regulatory guidance apply it consistently and clearly document the basis for audit conclusions.

Strong written verbal interpersonal and presentation skills including the ability to provide constructive provider feedback.

Ability to organize and prioritize multiple assignments work independently maintain confidentiality and meet deadlines.

Commitment to accuracy integrity professionalism collaboration and continuous improvement.

Work Requirements

Occasional travel to clinical office locations may be required.

Performs other compliance coding auditing and job-related duties as assigned.

Schedule:

• Monday-Friday: 8:30am-5:00pm

Benefits:

We offer a competitive compensation package including:

• Medical Dental and Vision insurance
• Companypaid longterm disability
• Flexible Spending Account (FSA)
• Companypaid life insurance and voluntary life insurance
• 401(k)
• Pet insurance

About ENT and Allergy Associates (ENTA)

ENT and Allergy Associates (ENTA) is the largest ENT Allergy and Audiology practice in the country with over 475 clinicians practicing across 70 clinical locations in New York New Jersey Pennsylvania and Texas.

Each ENTA clinical office is comprised of world-class physicians who are specialists and sub-specialists in their respective fields delivering the highest level of expertise and care to patients of all ages.

Our comprehensive services include:

• Adult and Pediatric ENT and Allergy
• Voice and Swallowing
• Advanced Sinus and Skull Base Surgery
• Facial Plastics and Reconstructive Surgery
• Treatment of Inner Ear Disorders and Dizziness
• Asthma-related services
• Diagnostic Audiology and Hearing Aid Dispensing
• Sleep and CT Services

ENTA is affiliated with some of the most prestigious medical institutions in the world. Each year ENTA physicians are recognized as Top Doctors by Castle Connolly reflecting our strong commitment to exceptional patient care and clinical excellence.

HÜMI:

Backed by over 25 years of experience Hümi (formerly Quality Medical Management Services USA LLC or QMMS USA) specializes in healthcare management and consultancy across practice operations and management technology revenue cycle compliance HR management and business applications. With a seasoned team and a commitment to excellence Hümi delivers cutting-edge healthcare business management solutions. By implementing best practices at every step Hümi ensures measurable success for its its core Hümi represents the human side of healthcare where operational excellence meets a people-first philosophy.

ENT and Allergy Associates is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.