Medical Claims Coding Auditor

3 weeks ago


Wilmington DE, United States ChristianaCare Full time

ChristianaCare is searching for a Corporate Compliance & Privacy Auditor to join the team.This position will execute moderate-to-complex level audits and participate in the evaluation of the adequacy, effectiveness, and efficiency of internal controls and identify weaknesses, along with providing recommendations to mitigate those weaknesses. This position is required to be able to work under limited supervision.
Education and experience requirements:
At least one of the following degrees is required:
Associates or Bachelor's degree in Nursing (active/unrestricted license)
Associate or Bachelor's degree in Health Information Management (RHIA or RHIT)
Equivalent experience of 5+ years' experience in provider auditing, claims auditing, compliance auditing, quality assurance, and/or recovery auditing
Coding Certification (at least one of the following are required and are to be maintained as a condition of employment)
Certified Professional Auditor (CPMA); Certified Professional Coder (CPC); Certified); Certified Coding Specialist (CCS); In-depth knowledge of ICD CM, ICD PCS and CPT/HCPCS coding systems.
Must be proficient in DRG/APC structure, National Correct Coding Initiatives, ICD CM/PCS Official Guidelines, Outpatient Prospective Payment System and Coding Clinic References. Current working knowledge of encoder/grouper. Strong analytical and communication skills.
Candidates who hold a CCDS or CPC will be given consideration but will need to obtain an inpatient coding certification within 1 year of their hire date with the company.
Experience in auditing education techniques and methods preferred, but not required.

Principal duties and responsibilities:
Review documentation to ensure appropriate assignment of DRG, ICD-9 codes, CPT codes, and modifiers for facility-based and provider-based clinical documentation, medical necessity, and/or inpatient coding and has a high level of understanding in reimbursement guidelines specifically an understanding of the MS-DRG, AP-DRG and APR-DRG payment systems.
Maintain a working knowledge of coding guidelines, HIPAA, and CMS regulations.
Participate in the planning and scheduling of compliance projects.
Work closely with providers to ensure accuracy in the coding and documentation of service.
Train new providers in coding and documentation responsibilities.
Research compliance related coding questions upon request from departments and/or practices.
Identify and report potential audit and compliance risks.

SPECIAL REQUIREMENTS:
Must maintain current AAPC certification.

When you become an employee at ChristianaCare, you are joining a robust healthcare organization that truly cares about their patients and their caregivers. For the second consecutive year, Forbes magazine has ranked ChristianaCare as one of the best large health systems to work for in the United States Guided by excellence and love, our Caregivers enjoy a multitude of employee benefits that include:
~ Full Medical, Dental, Vision and other insurance benefits
~403 (b) with an employer match
~ Generous paid time off with annual roll-over and opportunities to cash out
~12 week paid parental leave


About Christiana Care:ve
Headquartered in Wilmington, Delaware, ChristianaCare is one of the country’s most dynamic health systems, centered on improving health outcomes, making high-quality care more accessible and lowering health care costs. ChristianaCare includes an extensive network of outpatient services, home health care, medical aid units, two hospitals (1,227 beds), a Level I trauma center and a Level III neonatal intensive care unit, a comprehensive stroke center and regional centers of excellence in heart and vascular care, cancer care and women’s health. ChristianaCare is a not-for-profit teaching health system with more than 260 residents and fellows. We are continually ranked by US News & World Report as a Best Hospital. With our unique, data-powered care coordination service and a focus on population health and value-based care, ChristianaCare is shaping the future of health care.


  • Corporate Compliance

    3 weeks ago


    Wilmington, DE, United States ChristianaCare Full time

    ChristianaCare is searching for a Corporate Compliance & Privacy Auditor to join the team.This position will execute moderate-to-complex level audits and participate in the evaluation of the adequacy, effectiveness, and efficiency of internal controls and identify weaknesses, along with providing recommendations to mitigate those weaknesses. This position is...

  • Corporate Compliance

    3 weeks ago


    Wilmington, United States ChristianaCare Full time

    ChristianaCare is searching for a Corporate Compliance & Privacy Auditor to join the team.This position will execute moderate-to-complex level audits and participate in the evaluation of the adequacy, effectiveness, and efficiency of internal controls and identify weaknesses, along with providing recommendations to mitigate those weaknesses. This position is...

  • Hotel Night Auditor

    4 days ago


    Wilmington, United States Mckibbon Hospitality Full time

    This is a PART-TIME position, if interested in full time, additional hours may be considered. What Makes a McKibbon Hotel Front Desk Night Auditor? The hotel front desk night auditor is the main person to interact with guests during the overnight hours, typically 11pm -7am. As the face of the property, the night auditor has a relatable personality and a...

  • Hotel Night Auditor

    5 days ago


    Wilmington, United States McKibbon Hospitality Full time

    This is a PART-TIME position, if interested in full time, additional hours may be considered. What Makes a McKibbon Hotel Front Desk Night Auditor? The hotel front desk night auditor is the main person to interact with guests during the overnight hours, typically 11pm -7am. As the face of the property, the night auditor has a relatable personality and a...

  • Hotel Night Auditor

    18 hours ago


    Wilmington, United States McKibbon Hospitality Full time

    This is a PART-TIME position, if interested in full time, additional hours may be considered. What Makes a McKibbon Hotel Front Desk Night Auditor? The hotel front desk night auditor is the main person to interact with guests during the overnight hours, typically 11pm -7am. As the face of the property, the night auditor has a relatable personality and a...


  • Wilmington, United States Ametros Financial Corporation Full time

    Description: Ametros is changing the way individuals navigate healthcare by providing them with the tools and support necessary to make educated decisions on how to spend their medical funds. Ametros' team works closely with patients, insurers, employers, attorneys, brokers, medical providers, and Medicare to create a seamless experience for our clients....

  • Senior Auditor

    3 weeks ago


    De Pere, United States AGC CONSULTING LLC Full time

    Job Description Job Description ABOUT US Falcón Sánchez & Associates, a leading local CPA firm, is looking for a talented Senior Auditor that will add value to our firm and to our clients. Join us as we provide work-life balance during your experience of growth! EXPERIENCED ACCOUNTANT We are seeking suitably qualified high performing senior associates to...


  • Wilmington, United States Ivira Health Full time

    **About our company**: Ivira Health is a leading healthcare organization dedicated to improving patient outcomes and providing quality healthcare services. We are seeking a skilled and experienced Prior Authorization Specialist to join our team and contribute to our mission of ensuring seamless medication access for our patients. **Job Summary**: As a Prior...

  • Coding Educator

    4 weeks ago


    Newark, DE, United States ChristianaCare Full time

    Do you want to work at one of the Top 100 Hospitals in the nation? We are guided by our values of Love and Excellence and are passionate about delivering health, not just health care. Come join us at ChristianaCare!ChristianaCare, with Hospitals in Wilmington and Newark, DE, as well as Elkton, MD, is one of the largest health care providers in the...


  • Wilmington, United States Premier Oral & Facial Surgery Full time

    The offices are the State-of-the-Art facilities located in Wilmington and Newark. Office hours: 8-430 PM Monday to Thursday, Friday 8-130PM Positions: full-time or part-time 2 years of dental experience & insurance coding are required. **Primary Job Responsibilities**: Scheduling, patient check in and check out Collecting and posting payments Daily...

  • Sr Billing Liaison

    6 days ago


    Wilmington, United States Nemours Foundation Full time

    Nemours is seeking a Senior Billing Liaison to join our Nemours Children's Health team. This is a remote position. The Billing Liaison/Coder primary job responsibilities include ensuring 100% charge capture by reviewing physician dictated notes and operative reports and properly code all services performed utilizing appropriate CPT, IDC-9-CM codes and...


  • Wilmington, DE, United States ChristianaCare Full time

    Do you want to work at one of the Top 100 Hospitals in the nation? We are guided by our values of Love and Excellence and are passionate about delivering health, not just health care. Come join us at ChristianaCare!ChristianaCare, with Hospitals in Wilmington and Newark, DE, as well as Elkton, MD, is one of the largest health care providers in the...


  • Wilmington, United States Riccobene Associates Family Dentistry Full time

    The Remote Outstanding Insurance Specialist is a critical role responsible for effectively and efficiently managing the accounts receivable process for an assigned group of payors or supported region/company. This is an in office position. Responsibilities • Ensures claims are processed accurately to secure timely payment. • Responds to inquiries,...


  • Wilmington, DE, United States Department of Veteran Affairs Full time

    Overview: We are seeking a skilled and experienced Oral Surgeon to join our medical team. As an Oral Surgeon, you will be responsible for performing surgical procedures to treat various medical conditions. You will work at the Veterans HealthCare Medical Center, providing high-quality care to Veterans. If you are passionate about surgery and have the...


  • De Witt, United States PMA Insurance Group Full time

    Investigates, evaluates and resolves complex and litigated Commercial Automobile and General Liability claims for a large self-insured dedicated client. Provide a superior level of customer service to internal and external business partners. Administers and resolves claims in a timely manner and in accordance with client, company and regulatory guidelines....


  • Wilmington, DE, United States Coral Springs Rehabilitation and Nursing Center Full time

    Coral Springs Rehabilitation and Healthcare Center in beautiful Wilmington, DE is looking for a Full Time Cook to join our Team! Previous cook experience a MUST! Dietary Cook Responsibilities: The Dietary Cook supervisor cooks and prepares meals when needed. The Dietary Cook plans food production to coordinate with meal serving hours; cook supervisor...


  • Wilmington, United States AllGyn Full time

    **Billing/Insurance Coordinator**: - This individual needs to be experienced in dealing with insurance companies: credentialing, verifying, follow up on claim submissions and denials. - A person who has 2 to 5 years of experience would be ideal. - One should also have knowledge of ICD and CPT coding. - This individual should be flexible and personable; as...


  • Wilmington, United States AllGyn Full time

    Billing/Insurance Coordinator:This individual needs to be experienced in dealing with insurance companies: credentialing, verifying, follow up on claim submissions and denials.A person who has 2 to 5 years of experience would be ideal.One should also have knowledge of ICD and CPT coding. This individual should be flexible and personable; as well as socially...


  • Wilmington, United States Healthcare Practice Management Inc HCPM Full time

    Job DescriptionJob DescriptionPRIMARY FUNCTION:Health Care Practice Management was founded in 1992 on the foundation of cultivating relationships with our clients in order to service and provide exceptional medical billing services to support their practice. Our 46 clients, all within 22 specialties, span from DE, PA, MD, and FL. We are seeking a qualified...


  • Wilmington, DE, United States Nemours Children's Health Full time

    The associate nurse manager (ANM) position is responsible for collaborating with the nurse manager (NM) in all aspects of operational and administrative support of nursing associates and expanding nursing leadership presence in the practice area. Responsibilities in partnership with the NM, include planning, development and utilization of human and material...