Job Title: Healthcare/ Coder Compliance Auditor
To support the Corporate Compliance Department in its role of evaluating compliance with internal policies and external guidelines by performing audits of medical records, professional coding, and billing practices. The Compliance Auditor will facilitate education to resident physicians, employed physicians, and midlevel providers regarding effective documentation, coding, and billing practice. Conduct professional billing audit requirements set forth within the Professional Services Documentation and Coding Audits Policy.
Principal Duties and Responsibilities:
- Maintain professional working relationships with key stakeholders, billing auditors, and members of leadership.
- Investigate issues and work collaboratively with the compliance team; demonstrates problem solving strategies and recommend corrective action for deficiencies.
- Maintains in-depth knowledge of Medicare and Medicaid billing practices, coding guidelines, laws and regulations to ensure accurate Medicare and Medicaid billing.
- Researches coding and billing questions upon request from the department or practice and provide complete and accurate response.
- Uses coding knowledge in performing regular chart audits for compliance in Evaluation and Management coding. Preparation of reports and action plans as needed. Communicate audit results in a professional manner.
- Uses knowledge of primary or specialty care associations to design and create documentation forms to support accurate coding.
- Develops and presents educational materials to enhance documentation skills of providers to ensure correct coding of services.
- Develops education initiatives for employed physicians, residents, and midlevel providers including physician rules, regulations, and standards.
- Facilitates, assists, and works collaboratively with external consultants.
- Use of benchmarking tools to gather data and identify unfavorable trends.
- Perform assigned work safely, adhering to established departmental safety rules and practices; report to supervisor, in a timely manner, any unsafe activities, conditions, hazards, or safety violations that may cause injury to oneself, other employees, patients and visitors.
- Performs other related duties as required.
Education and Experience Requirements:
- Four to five years of medical audit experience required.
- Knowledge of physician and hospital billing systems required.
- Bachelor’s degree preferred. Courses in finance are helpful.
- An equivalent combination of education and experience may be substituted.
Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community, and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.
Christiana Hospital, Newark, Delaware:
This 1,007-bed, 1.3-million-square-foot modern facility provides a level of care only available in large-scale teaching hospitals. Christiana Hospital includes Delaware’s only Level-I Trauma center (as verified by the American College of Surgeons), which is prepared to handle the most extreme medical emergencies. In fact, it is the only Level-I Trauma center on the East Coast corridor between Baltimore and Philadelphia. Christiana Hospital has also been nationally recognized in U.S. News & World Report’s Best Regional Hospitals rankings as #1 in Delaware and #3 in the Philadelphia metro area, plus High Performing in 9 Adult Procedures/Conditions.