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
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
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
Use of benchmarking tools to gather data and identify unfavorable
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
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
- CPC - Certified Professional Coder Certification
Requisition # 44257
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,
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.