Compliance Medical Auditor - SB Clinical Practice Management

Compliance Medical Auditor - Stony Brook CPMP Compliance

Location: St. James, NY (At the manager’s discretion, this role may be eligible for remote work; this position is only available to New York State Residents).  

Schedule: Full Time

Days/Hours: 8am - 4:30pm

Salary Range: $69,715 - $76,854 (pay will be determined based on experience, preferred qualifications, and education)

Our compensation philosophy aims to provide marketable compensation programs and to compensate employees based on relevant experience and education. Individual compensation discussions begin during the hiring process and may occur during job review and promotional opportunities. Salaries vary depending on experience, education and current market for the position. Human Resources determines the external and internal equitable salary for each employee. 

SUMMARY: The SB Clinical Practice Management Plan, Inc. (CPMP) Compliance Medical Auditor supports the functions of the Compliance Program for CPMP and its University Faculty Practice Corporations to be compliant with Federal and State guidelines in the prevention of fraud, waste, and abuse. The Compliance Medical Auditor will participate and provide duties such as but not limited to conducting auditing and monitoring; providing training and education; assessing compliance with policies, procedures, and regulations; and identifying and recommending strategies for process improvements. The Compliance Medical Auditor performs auditing and monitoring of clinical documentation, analyzing medical records, and assessing the accuracy of ICD-10-CM diagnosis code and CPT assignments; and determining compliance with Federal and State regulations and guidelines. These audits and other projects are identified considering risks identified in State and Federal work plans, industry communications, fraud alerts, regulatory agencies, data mining using software applications, or per management’s request.

Responsibilities and Duties:

• Conduct medical record documentation and coding/billing audits assessing the accuracy of CPT codes, diagnoses, and modifier assignments; determining compliance with appropriate policies, procedures, bylaws, clinical staff rules and regulations, and federal and state regulations, and the timeliness of documentation.
• Collaborate with colleagues on audits and projects as needed. Produce high-quality work that is competently and efficiently performed in accordance with department standards. Monitor to identify patterns, trends, and variances during and from audits.
• Develop reports from the audit results and/or other sources and assess the need for further review or intervention.
• Participate in the preparation and delivery of compliance education and training programs and remedial education with Providers.
• Conduct follow-up audits as indicated to appraise the adequacy of corrective actions and determine whether deficiencies are corrected; prepare the appropriate reports for management.
• Serve as a coding, documentation, and policy and procedure resource providing regulatory guidance to Providers, employees, and management.
• Research relevant regulations and communicate the need for policies and procedures and education.
• Maintain a current working knowledge on regulatory requirements associated with professional coding, billing, documentation, and reporting requirements in an academic medical center and in hospital clinics and physician offices.
• Seek ongoing training and development to gain additional expertise in fulfilling the elements of an effective compliance program.
• Maintain professional skills and knowledge through attendance at relevant educational programs, participation in professional organizations and applicable webinars, and by reviewing current literature.
• Other projects as assigned.

Required Qualifications:

• Associate's degree or graduation from a medical billing and coding program.
• Current coding certification through the American Academy Professional Coders (AAPC) or the American Health Information Management Association (AHIMA).
• Ability to work collaboratively with physicians, non-physician practitioners, staff, and leaders of clinical, financial, and other departments.

Preferred Qualifications:

• Bachelors' Degree.
• Experience with IDX and Cerner.
• Experience using auditing software
• Prior experience within an academic healthcare hybrid entity.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to communicate with patients, staff and medical providers. The employee must be able to exchange accurate information in these situations. This position is largely sedentary and requires the employee to remain stationary for a majority of the day. Any additional physical demands will be outlined and provided by management. 

The responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of CPMP. 

StaffCo is a Professional Employer Organization, commonly referred to as a PEO, duly organized and registered under the New York Professional Employer Organization law. StaffCo and SUNY have entered into a professional employer agreement under which StaffCo is the employer of Stony Brook Clinical Practice Management Plan employees and responsible for all aspects of employment, including hirings, promotions, disciplines, terminations, the day-to-day direction and supervision of work, as well as labor relations and collective bargaining. StaffCo is fully responsible for providing all payroll and human resources services, including the payment of wages, collecting and reporting payroll taxes and maintaining any and all employee benefits.  SUNY Stony Brook Hospital is responsible for the operation of the hospital and provision of health care and is the co-employer as is necessary to conduct its responsibilities and for related licensure, regulatory or statutory requirements and obligations.    

Given StaffCo’s employment responsibilities, it is deemed the “employer” for employment and labor law purposes.  Thus, the employees are private sector employees of StaffCo, not public sector employees of SUNY.  The private sector nature of the StaffCo employees has been approved by NYS Civil Service and upheld in a decision by the US National Labor Relations Board. 

CPMP provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, gender identity or expression, or any other legally protected status.  This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall and transfer, leaves of absence, compensation and training.

CPMP expressly prohibits any form of workplace harassment based on race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, gender identity, or any other legally protected status.  Improper interference with the ability of CPMP’s employees to perform their job duties may result in discipline up to and including discharge.