Senior Compliance Specialist

Position Summary

Senior Compliance Specialist (Hospital Billing Auditor) to support the Manager of Hospital Billing Compliance and the Director of Billing Compliance in developing and implementing the Hospital Billing Compliance program. Primary responsibilities include conducting audits to determine the organizational integrity of billing facility and technical hospital fees, identifying areas requiring improvement, and providing recommendations and education to providers and staff.

Job Responsibilities

1. Assists with management of the comprehensive Hospital Billing Compliance workplan to ensure that billing and coding of hospital services are in accordance with federal, state, local and managed care payor regulations.
2. 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.
3. Conducts Hospital Compliance audits consisting of evaluation of adequacy and accuracy of documentation in support of services billed, including ICD/CPT/HCPCS and other third‑party payor codes, DRG assignment, APC code assignment, medical necessity of services, and compliance with other documentation, coding and billing standards.
4. Adheres to audit timeline and audit protocol standards; assists with development of audit schedules.
5. Prepares written reports of audit findings and recommendations and presents the findings to leadership of the respective department, coding staff, Health Information Management staff and others as appropriate; evaluates the adequacy of management action plan, as needed, to improve deficiencies.
6. Evaluates the adequacy and effectiveness of internal and operational controls designed to ensure that processes and practices lead to appropriate execution of regulatory requirements and guidelines related to facility and technical fee documentation, coding and billing, including federal and state regulations and guidelines, CMS and other third‑party payor billing rules, and OIG/OMIG compliance standards.
7. Develops a comprehensive education program to train department managers, staff and physicians in all areas of compliance and billing requirements; provides information which is clear and coherent. Prepares presentations and develops training materials as needed.
8. Assists Compliance Department management with federal, state and other special investigations and audits.
9. Effectively maintains collaborative working relationships with department leadership and Revenue Cycle Operations management team to provide education on improvements in billing and documentation practices.
10. Serves as subject matter expert and authoritative resource on interpretation and application of documentation and coding rules and regulations and medical necessity of services delivered.
11. Annually identifies specific needs for self‑development and implements a plan to achieve professional growth.
12. Maintains privacy of patient information and confidentiality of compliance information and activities.
13. Assists in any special projects and/or internal or external federal or state agency inquiries and performs and participates in other related duties as required.

Minimum Qualifications

• Bachelor’s degree in Finance, Healthcare Administration or 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.
• Must be able to communicate 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 health care setting.
• 4–5 years of experience in facility fee auditing/coding or medical necessity reviews or related work.
• Ability to understand and interpret medical records, hospital bills, and the charge master as well as an understanding of all ancillary department functions.
• Holds 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 and ability to work collaboratively with team members and others.

Qualified candidates must be able to effectively communicate with all levels of the organization.

NYU Langone Health provides a salary range of $84,577.92 – $142,767.54 annually. Actual salaries depend on a variety of factors, including experience, specialty, education, and hospital need. The salary range does not include bonuses, incentive pay or other forms of compensation or benefits.

NYU Langone Health is an equal opportunity employer and is committed to inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply.