Posting Number 2017-3304 Location US-NY-New York Posted Date 6/23/2017 Union N/A School/Division College of Dentistry (DN1032) Department Name : Clinical Revenue Cycle and Clinical Support Services FT/PT Full-Time
Under the supervision of the Director of Clinical Revenue Cycle Management and Data Integrity, the Assistant Director, Financial Compliance and Data Audits design, plan and execute compliance audits on statistical samples of claims to determine whether Oral Care services are accurately coded, in accordance with services rendered based on contractual requirements, and/or supported by adequate documentation, aligned with insurance (Medicaid (Article 28 and Managed Care) and commercial insurance) established contractual obligation. Perform various audits including complex audits on departments/individual with a focus on the Claims Adjudication process to identify exceptions to established claims adjudication requirements for claims processing, payment posting and procedural accuracy. Prepare written reports summarizing audit findings including utilization of statistical audit software to identify negative trends in billing practices. Provide feedback on departmental activities, to assure compliance with all health plan and regulatory agencies, including CMS and DOH. Identify compliance risk areas and assists with the development and implementation of policies and corrective action plans where indicated. Participate in staff training and recruitment.
Required Education: Bachelor’s degree in Accounting, Finance, Business or Health Care Administration
Preferred Education: Master’s degree in Business or Health Care Administration
Required Experience: 5+ years’ relevant professional level experience in a claims processing environment including related experience in a quality
Preferred Experience: Experience working in an Academic Dental Center, major dental group practice or Claims Adjudication area of an Insurance Carrier.
Required Skills, Knowledge and Abilities: Effective planning, analytical, communication and project management skills. Proven ability to develop and implement audit plans that will assess the effectiveness of NYU Dentistry controls and processes to support best in class business practices. Expert ability to read, extract and interpret patient financial data as it relates to clinical documentation and diagnosis/procedural coding of services provided. Expertise in Microsoft Office suite and statistical audit software. Comprehensive knowledge of regulations governing Article 28 and dental quality assurance program.
Preferred Skills, Knowledge and Abilities: Knowledge of Medicaid and HIPAA including administrative best practices for dental and/or health-care environment.
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