Title : Billing and Clinical Compliance Manager
Location : Midtown
Org Unit : The Office of Compliance
Work Days : Monday-Friday
Weekly Hours : 35.00
Exemption Status : Exempt
Salary Range : $110,500.00 - $124,100.00
- As required under NYC Human Rights Law Int 1208-2018 - Salary range for this role when Hired for NYC Offices
Position Summary
Oversees audit and education activity for clinical services in accordance with the Professional Compliance Plan. Ensures accurate and complete documentation, real-time monitoring, regulatory based education, and corrective action plans for all surgical programs.
Job Responsibilities
Monitors auditing and medical record documentation compliance with federal and state regulations. Educates clinical staff, department staff, and providers on compliant documentation.Provides guidance and tools to assist departments improve compliance metrics. Partners with department compliance liaisons to develop monitoring programs.Conducts prospective and retrospective compliance documentation audits. Designs tools and methodology for conducting audits. Tracks and trends results of audits. Prepares and presents reports on audit results.Reviews surgical complaints / incidents and designs scope of audits; identifies resources needed to determine compliance.Serves as a resource to clinical departments on coding, documentation and regulatory guidelines.Responsible for designing and conducting focused new provider education programs that is specific to each new provider.Develops, prepares and presents reports and compliance metrics.Performs routine and special compliance audit and monitoring as deemed necessary, including but not limited to, the management sanction screening, OMIG, CMS, and OIG compliance, and payer compliance.Assists the Chief Privacy and Compliance Officer with the development and implementation of the annual compliance risk assessment and work plan.Develops training tools and materials to assist in the conduct and delivery of clear and concise education to WCM provider, clinical and department staff on compliance documentation and guidelines.Manages the Compliance team within the Compliance office and has responsibility for surgical compliance activity throughout WCM.Partners with peers on ensuring that compliance staff are trained on surgical documentation, auditing, and education.Reviews the implementation of corrective action plans. Identifies trends in billing, coding and documentation errors and recommends corrective action plans. Monitors implementation of corrective action plans.Develops, implements and conducts surgical compliance webinars and lectures ensuring that information is updated and current. Conducts general compliance and path lectures for WCM community.Assists in development of WCM compliance policies and procedures, workflows and training materials.Performs other related duties as assigned.Education
Bachelor's DegreeExperience
10 years of relevant experience can be considered in lieu of Bachelor's Degree.5 years' experience in medical coding and 3 years' of auditing experience.Must have at least 2 years' of compliance department experience.Must have at least 3 years of professional services auditing experience.Must have 2 years' experience managing staff.Experience working in Epic desired.Experience in MDaudit desired.Experience in Surgery Compliance Preferred.Knowledge, Skills and Abilities
Proficiency in auditing providers and auditors and conducting education feedback sessions.Proficiency in identifying regulatory source for documentation guidance.Analytical skills to synthesize a high volume of information from a variety of sources and perform complex analysis to interpret compliance data / trends complex analysis from a variety of sources.Licenses and Certifications
Certified Professional Coder Certificate (CPC)Working Conditions / Physical Demands
Weill Cornell Medicine is a comprehensive academic medical center that is committed to excellence in patient care, scientific discovery, and the education of future physicians and scientists in New York City and around the world. Our doctors and scientists - faculty from Weill Cornell Medical College, Weill Cornell Graduate School of Medical Sciences, and the Weill Cornell Physician Organization - are engaged in world-class clinical care and cutting-edge research that connect patients to the latest treatment innovations and prevention strategies. Located in the heart of the Upper East Side's scientific corridor, Weill Cornell Medicine's powerful network of collaborators extends to its parent university Cornell University; to Qatar, where an international campus offers a U.S. medical degree; and to programs in Tanzania, Haiti, Brazil, Austria and Turkey. Our medical practices serve communities throughout New York City, and our faculty provide comprehensive care at NewYork-Presbyterian Hospital / Weill Cornell Medical Center, NewYork-Presbyterian / Lower Manhattan Hospital, NewYork-Presbyterian Hospital / Brooklyn Methodist Hospital, NewYork-Presbyterian Hospital / Westchester Behavioral Health Center, and NewYork-Presbyterian / Queens. At Weill Cornell Medicine, we work together to treat each individual, not just their conditions or illnesses, as we strive to deliver the finest possible care for our patients - the center of everything we do. Weill Cornell Medicine is an Equal Employment Opportunity Employer. Weill Cornell Medicine provides equal employment opportunities to all qualified applicants without regard to protected status, including race, sex, sexual orientation, gender identity, national origin, color, age, religion, protected veteran or disability status, or genetic information.
Salary : $110,500 - $124,100
