Regulatory Affairs Associate (Compliance Medical Auditor)

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 Regulatory Affairs Associate at our Corporate office location.

SUMMARY:

The Regulatory Affairs Associate (Compliance Medical Auditor) supports the functions of the Compliance Program for ENT and Allergy Associates, LLP, (ENTA) 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 Produce high-quality work that is competently and efficiently performed in accordance with departmental 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
• 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
• 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

Required Qualifications:

• Associate's degree or graduation from a medical billing and coding program. Must have a 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:

• Bachelor's Degree Preferred
• Experience with NextGen.
• Experience using auditing
• Prior experience within healthcare

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 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 ENTA.

Company Description:

ENT and Allergy Associates, LLP is the largest and most comprehensive ear, nose, throat, allergy and audiology practice in the nation with 55 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 or contact us at:

ENT and Allergy Associates, LLP
660 White Plains Road, 4th Floor
Tarrytown, NY 10591
Tel: (914) 333-5800
Fax: (914) 333-2540