Junior Billing Compliance Coordinator

POSITION OVERVIEW:

The Corporate Compliance department supports the agency in maintaining compliance in all areas of operations. The department focuses on promoting a culture of compliance, preventing, and detecting fraud, waste, and abuse, and educating staff on their rights to report suspected non-compliance. The Junior Billing Compliance Auditor is responsible for supporting The Corporate Compliance Program within one or more of the agency divisions of service to ensure billing compliance requirements are being met. The Junior Billing Compliance Auditor under the Director of Corporate Compliance for billing will coordinate with senior compliance specialists, management, and staff to ensure that the Jewish Board achieves consistently high levels of compliance with all applicable billing laws and regulations; policies and procedures and the code of conduct and will respond to any matter in a timely manner.

KEY ESSENTIAL FUNCTIONS:

• Remain up-to-date and knowledgeable of all regulatory and guidance requirements.
• Conduct internal billing/claims audits agency wide.
• Participates and assist in coordinating Compliance Review Committee (CRC) meetings.
• Maintaining a matrix of regulatory updates division wide.
• Act as an independent auditor by reviewing compliance of all departmental procedures, policies, and practices to ensure compliance with agency requirements that mirror billing audits conducted by OMIG, CMS, 3rd party vendors, and MMCO’s.
• Maintain the recording hub of audits including report findings and performance improvement plans within a designated division of service.
• Identify areas of potential exposure and risk. Assist in the development of corrective action plans for the resolution of any risk issue and ensure implementation of same.
• Lead or participate in investigations of fraud, waste, and abuse of public funds.
• Respond to alleged violations of rules, regulations, and policies, et. al., evaluate complaints and/or recommend the initiation of any inquiry to their supervisor.
• Work collaboratively with program staff, and other support departments to address and mitigate identified areas of exposure.
• Coordinates the completion of regulatory mandated projects and supports the use of regulatory systems, organizing training activities as needed.
• Conduct trainings to staff around compliance needs, regulations and issues including facilitation of the Compliance piece of the agency.
• Participate in the agency wide accreditation preparation process and actual survey.
• Sustain an environment that fosters team member engagement, equity, inclusion and belonging. Establishes clear objectives tied to department and/or organizational strategic goals.
• Other duties as needed.

ADDITIONAL FUNCTIONS MAY INCLUDE:

• Special projects as assigned by agency leadership.

CORE COMPETENCIES for the position include:

• Strong ability to independently research, read, and accurately interpret complex regulatory materials such as state and federal regulations and guidance memos and apply the information to auditing activities.
• Engagement skills. Demonstrate and model effective engagement skills in all areas of interaction.
• Strong verbal and written communication skills; relative to implementation and interpretation policy and procedures within the corporate compliance arena
• Strong analytical skills to determine citation trends within potential risks
• Able to operate in a fast-paced work environment while effectively handling multiple and varied tasks with a clear focus on detail, productivity, and quality outcomes.
• Ability to maintain quality performance while working autonomously and collaboratively with both internal and external teams.

EDUCATIONAL / TRAINING REQUIRED (List all that is required to achieve this position):

• BA/BS required. MS/MA/MBA/MPA/LCSW/LMSW preferred.
• Experience in related fields (i.e., Behavioral Health, CASAC, Public Health, Public Administration, Social Work)
• Experience with state regulators including but not limited to, OCFS, OMH, OPWDD, OMIG, OASAS, DOHMH, NYS DOH, and ACS.
• One year auditing experience preferred.
• Strong interpersonal and verbal communication skills, ability to engage staff at all levels of responsibility.
• Project management and organizational skill along with an ability to work independently is necessary.
• Experience in a not-for-profit or social service setting.
• Prior experience in interpretation of regulation and/or policy development and implementation preferred.
• Excellent organizational, time management, written and verbal communication skills.
• Proven analytical and problem-solving skills.
• Ability to attend agency meetings, held during business hours.
• Certification in Lean Six Sigma preferred.

COMPUTER SKILLS REQUIRED (List the computer skills needed):

• Knowledge of personal computers, standard software, and database management.
• Intermediate proficiency in Microsoft Office Suite.
• Ability to quickly adapt to agency computer applications.

COMMUNICATION SKILLS:

• Ability to articulate the agency’s philosophy, mission, and goals to a varied audience.
• Ability to interview a variety of managers, employees, consumers, and their families.
• Ability to write reports, business correspondence and procedures for a wide audience.
• Ability to lead ad-hoc task forces and meetings, which may include all levels of management and employees.
• Ability to respond to inquiries or complaints, including those of a sensitive and confidential nature, from any of the following, if applicable, under a variety of circumstances, including adversarial situations: consumers, managers, employees, regulatory agencies, arbitrators, union representatives, vendors, or applicants.
• Ability to effectively present information to consumers, top management, and staff in verbal and written formats.
• Ability to recognize the need for confidentiality of information and to maintain such confidences.

WORK ENVIRONMENT / PHYSICAL EFFORT

• Noise level is consistent with levels usually present in an office, education, rehabilitation, industrial, workshop or health related environment.
• Hazards present are consistent with those common to an office, education, rehabilitation, industrial, workshop or health related environment.

VISUAL AND MANUAL DEXIERITY:

• The candidate should be able to read documents for analytical purposes such as computer information, software, computer graphic design programs, etc.
• Limited applications of manual dexterity and hand-eye coordination.