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New York, New York, United States Metropolitan Jewish Health System Full time{"title": "Compliance Auditor", "content": "OverviewAt Metropolitan Jewish Health System, we are committed to providing high-quality healthcare services to our patients and members. As a Compliance Auditor, you will play a critical role in ensuring that our health plans comply with Medicare, Medicaid, and MLTC regulations.ResponsibilitiesConduct audits and...
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Clinical Compliance Auditor
4 months ago
Are you a Registered Nurse with a passion for ensuring compliance? Join our team at VillageCare as a Full-Time Clinical Compliance Auditor and take the next step in your career from the comfort of your own home. This fully remote position offers a competitive salary ranging from $102,000 to $115,000, providing a rewarding opportunity for professional growth and development. As a key player in our dynamic team, you will have the chance to showcase your expertise in compliance analysis while contributing to the high standard of excellence we uphold in healthcare. Take the leap towards a fulfilling career with us today
You can enjoy great benefits such as PTO package, 10 Paid Holidays, Personal and Sick time, Medical/Dental/Vision, HRA/FSA, Education Reimbursement, Retirement Savings 403(b), Life & Disability, Commuter Benefits, Paid Family Leave, and Additional Employee Discounts. Join us in making a meaningful impact in the healthcare industry.
**HELLO, WE'RE VILLAGECARE**:
VillageCare is a community-based, not-for-profit organization serving people with chronic care needs, as well as seniors and individuals in need of continuing care and managed care services. Our mission is to promote healing, better health and well-being to the fullest extent possible. Our care is offered through a comprehensive array of community and residential programs, as well as managed care. VillageCare has delivered quality health care services to individuals residing within New York City for over 45 years.
**DAY TO DAY AS A CLINICAL COMPLIANCE AUDITOR**:
As a new Clinical Compliance Auditor at VillageCare, you can expect to conduct detailed reviews of clinical documentation, policies, and procedures to ensure compliance with regulatory standards. Your day-to-day responsibilities will involve identifying areas for improvement, communicating findings to relevant stakeholders, and developing action plans for remediation. With a schedule of Monday through Friday, 9:00am to 5:00pm EST, you will have the structure needed to thrive in this role. Collaborating with cross-functional teams, participating in training sessions, and staying informed about industry updates will be essential to your success. Embrace this opportunity to make a difference in the healthcare field with us
**WOULD YOU BE A GREAT CLINICAL COMPLIANCE AUDITOR?**:
To excel as a Clinical Compliance Auditor at VillageCare, you must possess a Bachelor's Degree in Business, Health Administration, Health Information Management, Nursing, Public Health, or a related field. Additionally, you need to hold an active Registered Nurse (RN) license and Medical Chart Coding & Billing (CPC, CMC, or CCS) certification. With a minimum of 3 years' experience in a managed care/health plan setting, focusing on auditing, monitoring, or providing quality assurance for Medicaid and/or Medicare plans, you will bring valuable expertise to the role. Your 3+ years of experience in auditing diagnosis data from medical records to ensure proper ICD-10 coding and compliance with risk adjustment requirements will be essential. Proficiency in utilizing ICD-10-CM, CPT, and HCPCS coding, as well as MS-DRG, AP-DRG, and APR-DRG payment systems, is crucial for success in this position.
**WILL YOU JOIN OUR TEAM?**:
