Auditing and Compliance Specialist

At Essen Health Care, we care for that! 

As the largest privately held multispecialty medical group in the Bronx, we provide high-quality, compassionate, and accessible medical care to some of the most vulnerable and under-served residents of New York State. Guided by a Population Health model of care, Essen has five integrated clinical divisions offering urgent care, primary care, and specialty services, as well as nursing home staffing and care management. Founded in 1999, our over 20-year commitment has fueled an unwavering dedication toward innovating a better healthcare delivery system. Essen has expanded from a single primary care office to an umbrella organization offering specialties from women’s health to endocrinology, from psychiatry to a vast array of other specialties. All clinical services are offered via telehealth or in-person at over 35 medical offices and at home through the Essen House Calls program. 

Essen Health Care is the place Where Care Comes Together! We are looking for the most talented and effective individuals to join our rapidly growing company. With over 1,100 employees and 400+ Practitioners, we care for over 250,000 patients annually in New York City and beyond. From medical providers to administration & operational staff, there is a career here for you. Join our team today!

Position Title: Auditing and Compliance Specialist

Job Summary: The Billing and Coding Compliance Specialist is responsible for ensuring that all billing and coding activities across the organization are accurate, compliant with applicable laws and regulations, and aligned with internal policies. Responsible for ensuring timely responses to Insurances regarding audit requests. This role works closely with billing staff, coders, healthcare providers, and compliance officers to identify risk, provide education, and ensure integrity in revenue cycle operations.

• Respond in a timely manner to Insurance audit requests.
• Review clinical documentation and coding to ensure appropriate CPT, ICD-10, and HCPCS codes are assigned.
• Identify and report compliance risks and recommend corrective actions to mitigate risk.
• Collaborate with customer service and billing staff to provide guidance, and feedback on patient disputes.
• Assist in the development, implementation, and enforcement of policies and procedures related to billing and coding compliance.
• Investigate and resolve coding or billing discrepancies.
• Prepare and maintain documentation of audit results, findings, and improvement plans.
• Support internal and external audits and respond to requests for documentation or clarification.
• Stay current on updates to coding regulations, payer policies, and compliance requirements.
• Participate in compliance committees and contribute to continuous improvement initiatives.

Education & Certification:

· High School Diploma or equivalent required; Associate’s or Bachelor’s degree preferred.

· Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent credential required.

· Certified in Healthcare Compliance (CHC) a plus.

Experience:

· Minimum of 3 years of experience in medical billing, coding, or compliance auditing.

· Strong knowledge of Medicare, Medicaid, and commercial payer rules.

· Familiarity with EHR and billing systems (e.g.,EWC).

Skills & Competencies:

· Strong attention to detail and analytical skills.

· Excellent communication and interpersonal skills.

· Ability to handle confidential information with integrity.

· Proficiency in Microsoft Office Suite, especially Excel and Word.

Working Conditions:

· Primarily office-based or remote with occasional travel for training or audits.

· Standard business hours with flexibility as needed to meet deadlines or address urgent compliance issue

Essen Health care is proud to be an equal opportunity employer, and we seek candidates who desire to work in and serve an ethnically diverse population.