Billing Auditor-QA535207

3 weeks ago

New York, United States Institute for Comm Living Full time
Job DescriptionJob Description

NOTE: All applicants must comply with ICL's vaccination policy. Individuals selected for employment cannot begin working until they provide verification that they are fully vaccinated against COVID-19 (with an FDA-authorized vaccine).

JOB SUMMARY

The Compliance Billing Auditor participates in the mission of the Department of Compliance and Quality Improvement which is to promote quality, integrity and compliance through ongoing monitoring, evaluation, consultation, education, investigation and the development of quality and compliance-related processes and products. This position audits designated clinical and/or administrative records for conformance to federal and state regulations, including Medicaid, Medicare, and other third party billing, and agency policy. While the primary and most frequent activity is auditing, audit findings would likely result in follow-up consultation and training. This position also provides ongoing training in regulations, standards, and agency policies and practices that bear on such processes as documentation to support billing and internal control procedures.

ESSENTIAL TASKS:

To perform this job successfully, an individual must be able to perform each essential duty listed satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions unless this causes undue hardship to the agency.

  1. Conduct audits of case records for documentation to support Medicaid billing invoices. Develop written reports of findings and recommendations for executive and program managers and Board of Directors' Committees as directed.
  2. Provide consultative, technical, and training support to program staff regarding billing documentation standards and strategies for enabling conformance to such standards. This includes presentations to new employees and periodic presentations to existing employees on billing-related standards and other designated topics.
  3. Abstract data from records to evaluate (a) conformance to billing documentation standards and (b) utilization of services in programs that bill Medicaid, Medicare or other third party billing for reimbursement of such services, and develop written reports of findings and recommendations for executive and program managers and Board of Directors' Committees as directed
  4. Serve as consultant or trainer to the organization for all departments and appropriate entities in the areas of billing and internal controls as directed.
  5. Maintain current knowledge of applicable federal and state laws, regulations and accreditation standards that pertain to the operations of programs that receive Federal, State, City or other third party funding for business and service delivery operations.
  6. Cooperate with the state Attorney General's Office or other legal entities, and organization officers in any compliance reviews or
  7. Perform other tasks as assigned.

ESSENTIAL KNOWLEDGE, SKILLS AND ABILITIES

  • Knowledge of Federal and New York State laws and regulations pertaining to the billing and or operations of outpatient clinics, diagnostic and treatment centers, treatment apartment programs, assertive community treatment and case management teams, and individualized residential alternative programs (IRA);
  • A strong knowledge base and experience in appropriate coding and billing practices; Knowledge of multiple reimbursement systems;
  • Knowledge of multiple third-party payer requirements;
  • Knowledge of Microsoft Office software, such as Excel;
  • Auditing skills;
  • Effective organizational skills (e.g. planning, scheduling, prioritizing tasks)
  • Effective problem-solving skills;
  • Effective interpersonal skills;
  • Strong analytical skills;
  • The ability to gather, analyze and evaluate facts and to prepare and present concise oral and written reports;
  • Ability to express self clearly both verbally and in writing;
  • Ability to work as a member of a team;
  • Ability to work independently;
  • Ability to establish rapport with physicians and other healthcare practitioners; and
  • Ability and willingness to work with culturally diverse employees.

QUALIFICATIONS AND EXPERIENCE

  • A Bachelor's degree in an accredited college or university in a related health care field or accounting/business degree; AND
  • 1- 3 years of experience performing audit related
  • Certified Professional Coder/Biller (Preferred)

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