Senior Compliance Specialist

About the Organization

NYU Langone Health is a fully integrated health system that consistently achieves the best patient outcomes through a rigorous focus on quality, resulting in some of the lowest mortality rates in the nation. Vizient Inc. has ranked NYU Langone the No. 1 comprehensive academic medical center in the country for three years in a row, and U.S. News & World Report recently placed nine of its clinical specialties among the top five in the nation. The system offers a comprehensive range of medical services across 6 inpatient locations, its Perlmutter Cancer Center, and over 320 outpatient locations in the New York area and Florida. With $14.2 billion in revenue this year, NYU Langone includes two tuition-free medical schools and a vast research enterprise with over $1 billion in active awards from the National Institutes of Health.

About the Role

The Senior Compliance Specialist (Hospital Billing Auditor) supports the Manager of Hospital Billing Compliance and the Director of Billing Compliance in developing and implementing the Hospital Billing Compliance program at NYU Langone Health System to ensure adherence with federal and state billing regulations. Primary responsibilities include conducting audits to determine organizational integrity of billing facility and technical hospital fees, identifying areas requiring improvement, and providing recommendations and education to providers and staff.

Responsibilities

• Assists with management of the comprehensive Hospital Billing Compliance workplan to ensure billing and coding of hospital services comply with federal, state, local, and managed care payor regulations.
• Conducts risk assessments to define audit priorities by evaluating previous audit findings, management priorities, ICD, APC and DRG utilization patterns, national normative data, CMS and PEPPER initiatives, OIG work plans and advisories, and healthcare industry best practices.
• Conducts Hospital Compliance audits, evaluating the adequacy and accuracy of documentation supporting services billed, including ICD/CPT/HCPCS and other third-party payor codes, DRG assignment, APC code assignment, medical necessity of services, and compliance with documentation, coding, and billing standards.
• Adheres to audit timeline and protocol standards; assists with development of audit schedules.
• Prepares written reports of audit findings and recommendations, presenting them to leadership, coding staff, Health Information Management staff, and others as appropriate; evaluates the adequacy of management action plans to improve deficiencies.
• Evaluates the adequacy and effectiveness of internal and operational controls designed to ensure processes and practices meet regulatory requirements related to facility and technical fee documentation, coding, and billing, including federal and state regulations, CMS and third-party payor billing rules, and OIG/OMIG compliance standards.
• Develops a comprehensive education program to train department managers, staff, and physicians in compliance and billing requirements; prepares presentations and training materials.
• Assists Compliance Department management with federal, state, and other special investigations and audits.
• Maintains collaborative working relationships with department leadership and Revenue Cycle Operations management to provide education on improvements in billing and documentation practices.
• Serves as a subject matter expert and authoritative resource on interpretation and application of documentation and coding rules, regulations, and medical necessity of services delivered.
• Annually identifies specific needs for self-development and implements a plan to achieve professional growth.
• Maintains privacy of patient information and confidentiality of compliance information and activities.
• Assists in special projects, internal or external federal or state agency inquiries, and performs other related duties as required.

Requirements

• Bachelor’s degree in Finance, Healthcare Administration, or a related field.
• Minimum of 4 years of hospital coding and billing experience.
• Certification in clinical coding is required.
• Strong problem-solving and analytical skills.
• Excellent verbal and written communication skills.
• Proficiency in Microsoft Office.
• Ability to communicate effectively with physicians, senior administrators, and office staff.
• Epic systems and/or EHR experience.

Preferred Qualifications

• Bachelor’s degree in Nursing or Master’s degree in Nursing.
• Hospital billing experience in a large academic healthcare setting.
• 4-5 years of experience in facility fee auditing/coding, medical necessity reviews, or related work.
• Ability to understand and interpret medical records, hospital bills, and the charge master, as well as knowledge of ancillary department functions.
• One of the following coding certifications: MPG-Certified Inpatient Coder (CIC), AHIMA-Certified Coding Specialist (CCS), or AHIMA Certified Coding Associate (CCA).
• Proficiency in payment review systems, hospital information systems, and clinical record information systems.
• Knowledge of regulatory agencies' requirements (CMS, NYS Medicaid, OIG, and OMIG).
• Strong quantitative, analytical, communication, and interpersonal skills, with the ability to work collaboratively with team members and others.

Benefits

NYU Langone Health provides a comprehensive benefits and wellness package designed to support employees and their loved ones at every stage of life. Offerings include:

• Financial security benefits and a generous time-off program.
• Employee resource groups for peer support.
• Access to a holistic employee wellness program focusing on physical, mental, nutritional, sleep, social, financial, and preventive care well-being.
• Extensive resources and services to enhance overall quality of life for employees and their families.

Pay

The salary range for this role is $84,577.92 - $142,767.54 annually. Actual salaries depend on factors such as experience, specialty, education, and hospital need. The range does not include bonuses, incentive pay, differential pay, or other forms of compensation or benefits.