Senior Compliance Analyst

US-NY-Yonkers
2 weeks ago
Job ID
2017-1157
# of Openings
1
Category
Accounting/Finance

Overview

The Senior Compliance Analyst is responsible for performing billing audits to ensure compliance to Medicaid coding and medical records documentation standards. Although daily reporting will be to the Compliance Supervisor, this position will have direct access and work frequently with the Corporate Compliance Officer, and the Manager Billing Compliance. She/he interacts frequently with all levels of personnel within the organization and handles highly confidential organizational information. Contributes to departmental goals and objectives by reviewing person’s Health supported billing practices against regulatory requirements. Assists with mitigating the risk of penalties and fines (which can be very material in amount) due to improper billing practices.          

 

Scope: The Senior Compliance Analyst will audit and evaluate the level of compliance of all agency Programs/departments towards applicable OMIG, OMH standards and various health authority regulation.

 

Responsibilities

  • Conduct billing and documentation reviews
  • Establish and adhere to the internal audit schedule on an annual basis
  • Monitor accurate and timely billing of all Medicaid and Manage Care programs
  • Analyze our existing billing procedures and software utilization
  • Conduct follow-up audits when necessary for non-compliance issues
  • Provide analysis and follow up with all billing related appeals
  • Ensure the setup of profiles in Electronic Medical Record for all individuals supported in the Article 31 clinic, Health Homes and HCBS programs
  • Recommend modification to billing systems and business processes
  • Support Finance Team in the selection of software for Medicaid Managed Care billing specific to Out-Patient Mental Health Services
  • Interprets internal/external business challenges and recommends best practices to improve products, processes or services                     
  • Leads others to solve complex problems; uses sophisticated analytical thought to exercise judgment and identify innovative solutions               
  • Conduct and oversee data analysis
  • Other duties as assigned by supervisor

Qualifications

  • Knowledge of CPT and ICD-10 terminology
  • Adequate knowledge of federal and New York State health care insurance regulations
  • Adequate knowledge of Managed Care, Medicaid, Medicare and electronic claims payments and billing processes
  • Bachelor’s degree in accounting or business from a four year college or university
  • Certification of Billing (ex. Certified Ambulance Coder or Certified Medical Biller)
  • Two to five years related experience, preferably with Non-Profit organization or agency
  • Advanced knowledge of Microsoft Office and electronic claims billing software
  • Ability to read and interpret documents such as New York State Office of Mental Health guidelines and ability to speak effectively before groups of customers or employees of an organization
  • Ability to work with mathematical concepts such as addition, subtraction, multiplication, and division
  • Ability to apply concepts such as fractions, percentages, ratios and statistical data to practical situations.

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