Compliance Manager/Auditor

Riverside Medical Group - Secaucus, NJ (30+ days ago)3.4

Riverside Medical Group is seeking an experienced Compliance Manager. The Compliance Manager must exhibit an understanding of coding concepts, AMA, CMS/OIG/Federal/State regulations and guidelines.

Responsibilities Include:

Coding Compliance Chart Audit Reviews:

  • Ability to audit and/or abstract code medical records for proper assignment of diagnoses specificity (including HCC/risk adjustment concepts) procedure codes, units, sites, modifiers, drugs, supplies, etc.
  • Review and assign, appropriate E&M level based on utilization of 95 and 97 guidelines
  • Ensure procedures, E&M and diagnosis reporting meet all AMA, both ICD9 and ICD10, HCC, Risk Adjustment Reporting, CCI, CPT, CMS and OIG Guidelines
  • Assists/performs audit reviews for risk assessment purposes or as needed to complete benchmarks
  • Assists/performs with internal and external audits for purposes of monitoring compliance to final resolution
  • Performs focused Compliance Audit Reviews as outlined in internal Coding Compliance Plans
  • New Provider chart reviews and documentation/coding education
  • Prepares written reports of audit findings to present to Director, Physicians or other parties

Coding Compliance - Risk and Baseline Assessment:

  • Applies knowledge of ethical coding principles and monitors revenue cycle activities to evaluate coding and identifies areas of needed review
  • Utilizes a risk-based audit approach and establishes preliminary scope of reviews, incorporates patterns and trending analysis based on performing review and alerting the Director of any areas of identified concern
  • Conducts investigations/audits reviews/communicates and works with other teams to resolve Coding Compliance issues
  • Recognizes and reports problems, errors and discrepancies in medical records.

Coding Compliance Educational Efforts:

  • Conducts audit reviews related to Coding Compliance initiatives and communicates/collaborates with Director and other teams regarding audit outcomes and educational areas of opportunity
  • Communicates and meets regularly with Providers regarding coding/documentation findings and/or changes or compliance issues
  • Meet with manager and assist in creating individual provider education plans tailored to provider's specific needs based on review findings
  • Provides education to Providers regarding appropriate documentation

Project Management:

  • Assist Mangers with management of special projects as assigned
  • Demonstrates the ability to manage multiple projects
  • Develops, maintains and implements tracking and reporting mechanisms related to compliance initiatives and projects
  • Produces frequent summaries/reports regarding project status
  • Ability to identify and report potential trends
  • Works with outside resources to coordinate projects.

Education, Certification, Computer and Training Requirements:

  • Proficient use of Microsoft Office Applications (Excel, Word, PowerPoint)
  • Experience with the use of automated Encoder and Clinical Abstracting Systems preferred
  • Associate's Degree minimum /Bachelor's Degree preferred
  • Work related experience: 2-3 years minimum / 5 -8 years preferred
  • Auditing experience: 1 year minimum / 2-3 years preferred
  • Coding Certification - CPC, CCS-P, CCA, RHIT or RHIA- OR
  • Auditing, Compliance & Billing or Practice Management Certifications -- CEMC, CPCO, CPMA, CCP-P, CHC, CPPM, etc. -- Required

Additional Requirements:

  • Knowledge of Medical Terminology, Anatomy & Physiology/ Medical Science required
  • Knowledge of ICD-9, CPT, HCPCS coding skills and ability to abstract code required.
  • Ability to access and research coding questions, efficiently and communicate solutions to providers and staff required.
  • Ability to perform surgical chart reviews required
  • Demonstrated proficiency with 1995 & 1997 auditing tools required
  • Maintains a current level of OIG, Compliance, CMS, Stark, and Fraud & Abuse Regulations
  • Maintains high level of specialty specific coding and auditing guidelines
  • Maintains current knowledge of advances in coding, auditing and compliance


  • Travel using personal vehicle is required to various locations (more than 1 mile)

Equal Opportunity Employer

Job Type: Full-time