Compliance Coordinator Analyst - Stony Brook Compliance
Location: St. James, NY
Schedule: Full Time - Monday - Friday 8:30am to 5:00pm
SUMMARY: This position will work in the Clinical Practice Management Plan’s Compliance office as a key member of the team who is responsible for maintaining all databases, tracking applications, and auditing software programs. The Coordinator/Analyst will be the point person charged with tracking compliance-related rules and regulations. The Coordinator/Analyst will work closely with department management to provide data from various internal and regulatory sources in the development of risk assessments and work plans.
Job Duties & Essential Functions:
- Act as lead in coordinating the auditing process by tracking newly hired providers, established providers chosen for an audit, as well as data mining using MDaudit software for areas identified as a potential risk for fraud, waste, or abuse.
- Maintain the master-system of record to manage compliance training for all Providers and provide reports of Provider status (e.g., new hire, remedial, focused, department) to compliance management.
- Responsible for running and analyzing reports to determine training needs by monitoring and identifying patterns, trends, and variances related to auditing results using MDaudit software and making recommendations to compliance management.
- Communicate with the compliance department administrative staff to deploy Provider notifications and scheduling of meetings based on the audit work schedule.
- Manage the TES work files to flag Providers for audit and review daily to determine claims in scope for audit and release all other claims for processing.
- Run and analyze reports using GE/IDX software to address claim edits.
- Ensure authorized billing and coding changes are completed timely and accurately in IDX.
- Prepare ad-hoc, quarterly, and annual reports for Department Administrators, UFPC Presidents, CPMP Compliance Committee, and CPMP Board of Directors as directed by compliance department management.
- Support the Compliance Program by researching billing rules and regulations and reporting findings to compliance management.
- Participate in identifying encounters for audit in TES work files when appropriate.
- Maintain and update as needed the training and education library and the Compliance Department intranet.
- Track regulatory revisions via such things as pertinent website updates, listservs, publications, announcements, or webinars.
- Collaborate and assist colleagues with Compliance Department projects as needed.
Required Qualifications :
- Associates Degree in a related field.
- Coding certification through the American Academy Professional Coders (AAPC) or the American Health Information Management Association (AHIMA). In lieu of certificate, two years’ experience with CPT and ICD-10-CM.
- Three years of full-time, progressively responsible administrative experience to include healthcare software application skills.
- Proficient with Microsoft Excel, including complicated formulas (e.g., Pivot Tables).
Preferred Qualifications :
- Bachelor’s Degree in a related field
- Experience with GE/IDX software applications and TES Claims Scrubber.
- Experience in maintaining databases.
- Experience with Cerner or other Electronic Medical Record.
- Experience with MDaudit software.
CPMP provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, gender identity or expression, or any other legally protected status. This policy applies to all terms and conditions of employment, including recruiting,hiring, placement, promotion, termination, layoff, recall and transfer, leaves of absence, compensation and training.