Job Description:

ENT and Allergy Associates, LLP and Hümi is seeking a self-motivated, people-friendly full time Regulatory Affairs Manager for our Tarrytown Corporate office location.

Salary: $100,652/year

Reporting directly to the Director of Regulatory Affairs, the Regulatory Affairs Manager is responsible for supporting and advancing ENT and Allergy Associates' ("ENTA") regulatory compliance, coding integrity, and documentation improvement initiatives. This role oversees coding audit activities, assists in the development and implementation of compliance programs, and serves as a key resource for physicians, auditors, and operational leadership regarding documentation, coding, and billing compliance.

The Regulatory Affairs Manager evaluates medical record documentation and claims submissions to ensure accuracy, completeness, appropriate reimbursement, and compliance with applicable federal and state regulations, payer requirements, and industry standards. The Manager also provides education and guidance to providers and staff regarding coding, billing, and regulatory requirements and serves as a subject matter expert in coding compliance and documentation best practices.

The ideal candidate possesses extensive knowledge of physician billing practices, payer regulations, CPT®, ICD-10-CM, HCPCS Level II coding systems, and Evaluation and Management (E&M) guidelines, including application of the [redacted] E&M documentation standards. Experience in Otolaryngology (ENT) and/or Allergy and Immunology is preferred.

Essential Responsibilities

Compliance & Regulatory Oversight

• Assist the Director of Regulatory Affairs in the administration and oversight of ENTA's compliance and coding integrity programs.
• Oversee internal coding audit activities and ensure consistency in audit methodology, reporting, and provider education.
• Support the development, implementation, and maintenance of compliance policies, procedures, and monitoring activities.
• Monitor regulatory developments, payer policies, coding updates, and industry guidance to identify organizational impact and recommend appropriate actions.
• Identify compliance risks, trends, and opportunities for process improvement through audit findings and data analysis.
• Collaborate with operational and clinical leadership to support regulatory compliance initiatives and corrective action plans.

Audit Management & Coding Compliance

Provide oversight to Coding Auditors to ensure the following activities are completed accurately and timely:

• Conduct audits of medical record documentation to identify coding, billing, and documentation deficiencies.
• Prepare detailed audit reports and communicate findings to providers and leadership.
• Deliver coding education and corrective guidance related to compliance risks and documentation improvement opportunities.
• Perform second-level reviews of billing and coding activities to validate compliance with payer requirements and regulatory standards while optimizing appropriate reimbursement.
• Research, analyze, and respond to inquiries related to coding, billing compliance, denials management, reimbursement issues, and documentation requirements.
• Assist in the review, development, and enhancement of policies, procedures, workflows, and data management systems affecting physician billing and compliance operations.
• Monitor monthly identified refund activity resulting from Medical Management Committee reviews and verify appropriate processing and resolution.
• Support external audits, governmental inquiries, payer reviews, and appeals by analyzing documentation, facilitating medical record submissions, and assisting with response preparation.
• Oversee the development, maintenance, and implementation of RCX rules and related compliance monitoring activities.

Education & Training

• Oversee the development of educational materials and training resources for providers, coding staff, and operational personnel.
• Coordinate and deliver coding, documentation, and compliance education programs.
• Promote ongoing provider and staff awareness of regulatory requirements, coding updates, and industry best practices.
• Serve as an internal resource and subject matter expert for coding, billing, and documentation compliance matters.

Qualifications

Education & Certifications

• Associate degree in Healthcare Administration, Health Information Management, Business Administration, or a related field required; Bachelor's degree preferred.
• One or more of the following certifications required:
  • CPC (Certified Professional Coder)
  • CCS or CCS-P
  • CPMA
  • CEMC
  • CENTC
• CHC (Certified in Healthcare Compliance) and/or CPCO (Certified Professional Compliance Officer) preferred.

Experience

• Minimum of three to five years of progressively responsible medical coding, auditing, or compliance experience within a physician practice setting.
• Prior experience overseeing coding audits, provider education, and compliance initiatives preferred.
• Experience in ENT and/or Allergy specialty coding strongly preferred.

Knowledge, Skills & Abilities

• Comprehensive knowledge of CPT®, ICD-10-CM, HCPCS Level II, and Evaluation and Management (E&M) coding guidelines.
• Thorough understanding of physician billing regulations, payer requirements, Medicare policies, and healthcare compliance standards.
• Strong analytical and problem-solving skills with the ability to evaluate complex documentation scenarios.
• Excellent verbal, written, presentation, and interpersonal communication skills.
• Advanced organizational skills with the ability to manage multiple priorities and deadlines.
• Proficiency with Microsoft Office Suite, including Excel, Word, PowerPoint, and Outlook.
• Ability to maintain confidentiality and exercise sound professional judgment.

Occasional travel to ENTA's clinical office locations will be required.

Performs miscellaneous job-related duties as assigned.

Benefits:

We offer a competitive compensation package, including:

• Medical, Dental, and Vision insurance
• Company-paid long-term disability
• Flexible Spending Account (FSA)
• Company-paid life insurance and voluntary life insurance
• 401(k)
• Pet insurance