Position Details
Position Information
| Recruitment/Posting Title |
Enterprise Risk Management & Healthcare Billing and Coding Associate Auditor |
| Job Category |
Staff & Executive - Healthcare - Administrative Services |
| Department |
UFA-Univ Ethics & Compliance |
| Overview |
Rutgers, The State University of New Jersey, is a leading national research university and the State of New Jersey's preeminent, comprehensive public institution of higher education. As one of the largest employers in the State of New Jersey, Rutgers University is committed not only to the students and the State that we serve, but also to the faculty and staff who work on our campuses. Ranked in 2022 by Forbes as a
top 100 best large employer in America,
Rutgers' commitment to its employees includes maintaining and fostering a safe, diverse, and respectful workplace environment, creating employment opportunities for our nation's military veterans, and ensuring accessibility and accommodation for individuals with disabilities.
University Finance and Administration (
UFA) advances Rutgers' strategic priorities through the management of all central financial, administrative, and student information systems and processes. We supply the university's financial community the professional guidance, services, tools, and information needed to make the informed decisions that contribute to Rutgers' standing as an academic, health, and research powerhouse. We are deeply committed to our
guiding principles and the core values that are critical for the long-term strategic growth of our division and the university. For more information, please visit
https://finance.rutgers.edu/.
University, Ethics and Compliance (
UEC) is committed to building an intentionally diverse, equitable and inclusive environment for all employees. We aim to collectively improve our understanding of the variety of personal experiences, values, and worldviews that arise from differences of culture and circumstance.
UEC is actively working to identify and eliminate barriers to create a more equitable workplace for all. Our goal is to have an inclusive work environment in which all individuals and groups feel welcomed, respected, supported, and valued. |
| Posting Summary |
Rutgers, The State University of New Jersey is seeking an Enterprise Risk Management & Healthcare Billing and Coding Associate Auditor for University Ethics and Compliance. Under the direction of the Director of Enterprise Risk Management and Healthcare Billing and Coding Audit ("Director"), the Enterprise Risk Management & Healthcare Billing and Coding Associate Auditor ("ERMBCAA") is responsible for assisting in the development and implementation of the University's Enterprise Risk Management Program and ensuring accuracy and compliance with federal, state and third-party payer rules and regulations governing proper documentation for Rutgers billing and coding practices. The position will assist in the generation of surveys that aid in the cataloging of risks and perform administrative duties in support of the
ERM program. The
ERMBCAA will provide professional, independent, and objective assessments of the healthcare professionals' services being audited which includes communicating those assessments by developing comprehensive reporting packages. The
ERMBCAA will be responsible for reviewing medical records, claims and other necessary documentation to ensure Rutgers healthcare professionals are adhering to coding guidelines and regulatory requirements. The
ERMBCAA will conduct required training and education to provide guidance to individual providers and/or departmental/divisional groups based on audit findings. The
ERMBCAA will also participate in internal investigations, conducting coding and billing analyses when such expert knowledge is required.
Among the key duties of this position are the following:
Perform risk-based audits
- Provides professional expertise in healthcare billing and coding by conducting risk-based audits to support workplan objectives.
- Assists in audit planning, including identifying risk areas, reviewing applicable coding and billing guidelines, and departmental policies/procedures.
- Selects and examines documentation, including medical records, to assess coding and billing accuracy and identify discrepancies.
- Evaluates coding practices against industry standards, regulations, and payer guidelines to ensure compliance.
- Communicates audit progress, findings, and recommendations to the Director, CBM, and Lead Auditor.
- Prepares Draft Reports with findings and recommended corrective actions for review by Lead Auditor, CBM, or Director; submit for final approval to the Deputy Chief or Chief University Compliance Officer.
- Issues Final Report following the Exit Meeting and receipt of management response from the department/division.
Training and Education
- Assists in developing, coordinating, and delivering training programs on billing and coding regulations to Rutgers healthcare professionals.
- Retrains healthcare professionals deemed non-compliant and conducts timely post-education audits.
- Develops training materials in consultation with UEC Compliance Officers, OGC, Labor Relations, and Employment Equity on topics such as federal/state law, University policies, and collective negotiations agreements.
Corrective actions
- Ensures timely receipt of written management responses to issue final reports.
- Evaluates responses for adequacy of planned corrective actions.
- Collaborates with Lead Auditor on options to address corrective actions.
- Monitors implementation and effectiveness of corrective action plans.
Assist with Internal Investigations
- Provides expertise in billing and coding to support UEC Investigations, including reviewing healthcare services and summarizing findings.
- Submits findings to assigned Investigator; if Lead Investigator, prepare Investigation Report and submit for final approval.
- Keeps Director, CBM, Lead Auditor, and Deputy Chief Compliance Officer informed of investigation status and findings.
Enterprise Risk Management
- Supports development, implementation, and coordination of the Enterprise Risk Management Program.
- Assists with risk assessments by gathering data, researching risks, maintaining the risk inventory, and supporting mitigation and monitoring efforts.
Compliance and Continuous Learning
- Maintains coding certifications and stays current with updates in ICD-10, HCPCS, CPT-4, and related laws, regulations, and policies.
- Expands knowledge through industry courses, webinars, and publications.
|
| Position Status |
Full Time |
| Hours Per Week |
|
| Daily Work Shift |
|
| Work Arrangement |
|
| FLSA |
Exempt |
| Grade |
05 |
| Position Salary |
|
| Annual Minimum Salary |
69031.00 |
| Annual Mid Range Salary |
87377.00 |
| Annual Maximum Salary |
105722.00 |
| Standard Hours |
37.50 |
| Union Description |
Admin Assembly (MPSC) |
| Payroll Designation |
PeopleSoft |
| Benefits |
Rutgers offers a comprehensive benefit program to eligible employees. For details, please go to
http://uhr.rutgers.edu/benefits/benefits-overview. |
| Seniority Unit |
|
| Terms of Appointment |
Staff - 12 month |
| Position Pension Eligibility |
ABP |
Qualifications
| Minimum Education and Experience |
- Bachelor's Degree, preferably in business administration, healthcare administration, health information management or an equivalent combination of education and/or experience.
- Two (2) years of experience in a healthcare billing and coding role, and as a healthcare auditor.
|
| Certifications/Licenses |
- Certified Professional Coding (CPC) or Certified Coding Specialist Physician (CCS-P) and/or related certification).
- A valid driver's license would be required for this position; Use of personal vehicle in order to travel for business demands.
|
| Required Knowledge, Skills, and Abilities |
- Experience with medical record review.
- Experience in risk management.
Knowledge:
- Possess an in-depth understanding of medical terminology, anatomy, physiology, and coding classification systems (ICD-10, CPT, HCPCS).
- Have a good foundational understanding of HIPAA regulations.
- Be aware of, understand and interpret the policies, rules, regulations, laws, and statutes pertaining to the engagement.
- Be well-versed in federal, state, and other third-party billing and coding regulations within the healthcare industry to ensure the institution is appropriately billing governmental (Medicare & Medicaid) and third-party insurers.
- Basic knowledge of risk identification and mitigation strategies.
Skills:
- Have strong analytical and critical thinking skills.
- Be observant, focused attention to detail and accuracy in reviewing medical records and billing documentation.
- Have the ability to understand and interpret trends, relationships, and problems from statistical data.
- Be able to apply coding and billing guidelines and regulations specific to individual audit assignment.
- Identify the appropriate audit technique for use depending on the circumstances of their assignment.
- Demonstrate effective teaching skills when providing training to healthcare professionals applicable to coding and billing guidelines.
- Possess satisfactory writing skills to write professional audit reports, letters, emails, workpapers and other service communications.
- Be proficient in using electronic health records (EHR) systems, coding and auditing software, and Microsoft Office Applications.
- Experience with various software packages that aid in the synthesizing of data into meaningful reports.
Abilities:
- Capture business processes, information and communication flows, and internal control systems, for analysis and evaluation to appropriately apply audit procedures. This work often involves reading, interpreting, and/or gaining an understanding of vast amounts of documentation, including, but not limited to: federal, state, and local statutes; administrative codes; federal and state agency mandates; contracts with external organizations; and university and departmental policies and procedures, and systems documentation.
- Be an excellent listener so that engagements serve clients' needs, while achieving the objectives of University Ethics and Compliance and the university.
- Have the ability to research updates and changes to billing and coding regulations.
- Express clearly and professionally in all communications.
- Possess strong computer skills to prepare reports, create spreadsheets, and utilize various data analytics, navigate various EHR systems and audit management software. The Associate Auditor should also be able to research the web.
- Have the self-discipline to progress on concurrent work assignments and tasks.
- Make professional and supportable judgments on every assignment.
- Take direction from the University Ethics and Compliance management team.
CBAA should possess high ethical standards and integrity with a commitment to maintaining confidentiality and compliance in all aspects of work.
|
| Preferred Qualifications |
- Recent healthcare auditing experience.
- Knowledge of data analytics software.
- Experience with project management.
- Experience working in an academic medical institution.
- Willingness to travel between campuses.
|
| Equipment Utilized |
- MDaudit Enterprise.
- Various EHR systems including Epic, Insight, Vista, Axium, Medaptus.
- ServiceNow.
|
| Physical Demands and Work Environment |
|
| Special Conditions |
|
Posting Details
| Posting Number |
25ST1074 |
| Posting Open Date |
05/09/2025 |
| Special Instructions to Applicants |
|
| Regional Campus |
Rutgers University-Newark |
| Home Location Campus |
Rutgers University-Newark |
| City |
Newark |
| State |
NJ |
| Location Details |
|
Pre-employment Screenings
All offers of employment are contingent upon successful completion of all pre-employment screenings. Immunization Requirements
Under Policy 100.3.1 Immunization Policy for Covered Individuals, if employment will commence during Flu Season, Rutgers University may require certain prospective employees to provide proof that they are vaccinated against Seasonal Influenza for the current Flu Season, unless the University has granted the individual a medical or religious exemption. Additional infection control and safety policies may apply. Prospective employees should speak with their hiring manager to determine which policies apply to the role or position for which they are applying. Failure to provide proof of vaccination for any required vaccines or obtain a medical or religious exemption from the University will result in rescission of a candidate's offer of employment or disciplinary action up to and including termination. Affirmative Action/Equal Employment Opportunity Statement
It is university policy to provide equal employment opportunity to all its employees and applicants for employment regardless of their race, creed, color, national origin, age, ancestry, nationality, marital or domestic partnership or civil union status, sex, pregnancy, gender identity or expression, disability status, liability for military service, protected veteran status, affectional or sexual orientation, atypical cellular or blood trait, genetic information (including the refusal to submit to genetic testing), or any other category protected by law. As an institution, we value diversity of background and opinion, and prohibit discrimination or harassment on the basis of any legally protected class in the areas of hiring, recruitment, promotion, transfer, demotion, training, compensation, pay, fringe benefits, layoff, termination or any other terms and conditions of employment. For additional information please see the Non-Discrimination Statement at the following web address: http://uhr.rutgers.edu/non-discrimination-statement |
Rutgers University
May 09, 2025