Job Description:

ENT and Allergy Associates, LLP New York & New Jersey's premier ENT and Allergy medical practice, is seeking a self-motivated, people-friendly full time Compliance Medical Auditor at our Corporate office location.

Salary: $80,000-$85,000

Summary:

The Regulatory Affairs Associate (Compliance Medical Auditor) supports the Compliance Program for ENT and Allergy Associates, LLP (ENTA) to ensure adherence to Federal and State guidelines aimed at preventing fraud, waste, and abuse. The Compliance Medical Auditor will perform duties such as, but not limited to, conducting audits and monitoring; providing training and education; assessing compliance with policies, procedures, and regulations; and identifying and recommending strategies for process improvements. The auditor reviews clinical documentation, analyzes medical records, evaluates the accuracy of ICD-10-CM diagnosis codes and CPT assignments, and verifies compliance with Federal and State regulations and guidelines. These audits and projects are selected based on risks identified through State and Federal work plans, industry communications, fraud alerts, regulatory agency guidance, data mining software, or management requests.  

Responsibilities and Duties:

• Perform audits of medical record documentation and coding/billing to verify the accuracy of CPT codes, diagnoses, and modifier assignments, ensuring compliance with policies, procedures, bylaws, clinical staff rules, regulations, and federal and state laws. Additionally, assess the timeliness of documentation.
• Collaborate with colleagues on audits and projects as needed. Deliver work of high quality that is performed competently and efficiently according to departmental standards. Monitor to identify patterns, trends, and variances during and after audits.
• Create reports based on audit findings and other sources, then assess whether further review or action is necessary.
• Assist in developing and presenting compliance education, training programs, and remedial education with Providers.
• Conduct follow-up audits as needed to assess the effectiveness of corrective actions and confirm that deficiencies are resolved; then, prepare the required reports for management.
• Serve as a coding, documentation, and policy and procedure resource providing Regulatory guidance to Providers, employees, and management.
• Research applicable regulations, and communicate the importance of policies, procedures, and education.
• Maintain up-to-date knowledge of regulatory requirements related to professional coding, billing, documentation, and reporting in an academic medical center, hospital clinics, and physician offices.
• Pursue continuous training and development to enhance your expertise in implementing effective compliance programs.
• Maintain professional skills and knowledge by attending relevant educational programs, engaging in professional organizations and webinars, and reviewing current literature.
• Other projects assigned.

Required Qualifications:

• Associate's degree or completion of a medical billing and coding program.
• CPC must hold a current coding certification from the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA).
• Ability to collaborate effectively with physicians, non-physician practitioners, staff, and leaders across clinical, financial, and other departments.

Preferred Qualifications:

•     CPMA Certification

•     Experience with NextGen or similar medical management systems.

•     Experience with auditing software.

•     Previous experience in a healthcare organization.

Please note this job description is not designed to cover or contain a completely comprehensive listing of activities, duties, and responsibilities that are required for this position. Duties, responsibilities, and activities may change at any time, or without notice.

We offer a competitive salary with a comprehensive benefits package including:

Medical/Dental/Vision insurance, Company paid long term disability, Flexible spending account, Company paid life insurance, Voluntary life insurance, 401k, Pet insurance.

Company Description:

ENT and Allergy Associates, LLP is the largest and most comprehensive ear, nose, throat, allergy and audiology practice in the nation with over 60 offices and over 300 Clinicians. Each ENT and Allergy Associates clinical location provides access to a full complement of services, including General Adult and Pediatric ENT, Voice and Swallowing, Facial Plastics and Reconstructive Surgery, Disorders of the Inner Ear and Dizziness, Asthma, Clinical Immunology, Diagnostic Audiology, Hearing Aid dispensing, Sleep and CT Services. ENTA has a clinical alliance with The Mount Sinai Hospital for the treatment of diseases of the head and neck and esophageal cancer and a partnership with the American Cancer Society to educate and treat patients with smoking disorders and cancer. The Practice has also expanded its clinical capabilities to include advanced Immunodeficiency trials.

To learn more about the benefits of ENT and Allergy Associates, or to conveniently find an ENT doctor or Allergy Doctor and then easily book an appointment at the nearest New York or New Jersey location, please visit: www.entandallergy.com

About Quality Medical Management Services USA, LLC (QMMS USA)

Backed by over 25 years of experience, Quality Medical Management Services USA offers healthcare consultancy services in the area of medical staff operations, practice management, ancillary service revenue enhancement, compliance, records management, and business applications. QMMS USA provides a seasoned team to offer leading edge healthcare business management. QMMS USA implements best practices throughout to ensure success.

To learn more about Quality Medical Management Services USA, please visit: www.qmmsusa.com

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