Compliance Coordinator Analyst

Compliance Coordinator Analyst - Stony Brook CPMP Compliance

Location: St. James, NY(At the manager’s discretion, this role may be eligible for hybrid remote work; this position is only available to New York State Residents)  

Schedule: Full time

Days/Hours: Monday - Friday; 8:30 AM - 5 PM 

Salary Range: $64,428 - $73,173 (pay will be determined based on experience, preferred qualifications, and education)

Our compensation philosophy aims to provide marketable compensation programs and to compensate employees based on relevant experience and education. Individual compensation discussions begin during the hiring process and may occur during job review and promotional opportunities. Salaries vary depending on experience, education and current market for the position. Human Resources determines the external and internal equitable salary for each employee. 

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:

• Collect and analyze data to prepare reports related to training and education, auditing, and regulatory work to identify trends and areas for improvement.
• 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. 
• 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.
• 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 or graduation from program in a related field.
• Knowledge of CPT and ICD-10-CM.
• Full-time progressively responsible administrative experience to include healthcare software application skills.
• Strong analytical skills and proficiency with Microsoft Excel, including complicated formulas (e.g., Pivot Tables).

Preferred Qualifications:

• Coding certification through the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA).
• 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.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to communicate with patients, staff and medical providers. The employee must be able to exchange accurate information in these situations. This position is largely sedentary and requires the employee to remain stationary for a majority of the day. Any additional physical demands will be outlined and provided by management. 

The responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of CPMP. 

StaffCo is a Professional Employer Organization, commonly referred to as a PEO, duly organized and registered under the New York Professional Employer Organization law. StaffCo and SUNY have entered into a professional employer agreement under which StaffCo is the employer of Stony Brook Clinical Practice Management Plan employees and responsible for all aspects of employment, including hirings, promotions, disciplines, terminations, the day-to-day direction and supervision of work, as well as labor relations and collective bargaining. StaffCo is fully responsible for providing all payroll and human resources services, including the payment of wages, collecting and reporting payroll taxes and maintaining any and all employee benefits. SUNY Stony Brook Hospital is responsible for the operation of the hospital and provision of health care and is the co-employer as is necessary to conduct its responsibilities and for related licensure, regulatory or statutory requirements and obligations.   

Given StaffCo’s employment responsibilities, it is deemed the “employer” for employment and labor law purposes. Thus, the employees are private sector employees of StaffCo, not public sector employees of SUNY. The private sector nature of the StaffCo employees has been approved by NYS Civil Service and upheld in a decision by the US National Labor Relations Board. 

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.

CPMP expressly prohibits any form of workplace harassment based on race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, gender identity, or any other legally protected status.  Improper interference with the ability of CPMP’s employees to perform their job duties may result in discipline up to and including discharge.