Compliance Coding Auditor

2 months ago

Wilmington, 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 has an exciting opportunity for a passionate, and hardworking healthcare coding professional to join our team. The Compliance Coding Auditor supports the department through assigned auditing activities to ensure effective documentation as well as accurate coding and billing. Through communication and training activities, they deliver information or clarification on audit results, compliance inquiries, coding, documentation standards, guidelines, and regulatory requirements. They provide operational, technical, and auditing and coding support for the Office of Compliance & Privacy.

The successful candidate will have proven experience with medical claims' billing/payment systems, provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology.

Education and experience requirements:

  • Associate or bachelor's Degree is required.

  • Equivalent 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 Coding Specialist (CCS) Certified Inpatient Coder (CIC)

  • 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, Inpatient and 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 (CIC) within 2 years of their hire date with the company.

  • Experience in coding auditing education techniques and methods preferred, but not required

Special requirements:

Must maintain current AAPC certification.

Principal duties and responsibilities:

  • Assists with reviewing internal and external inquiries regarding professional and hospital/clinical billing compliance matters, including government and third-party payor requests.

  • Provides support for provider, hospital/clinical billing and coding audits and focused reviews to ensure compliance with government and payor guidelines.

  • Assists with maintaining regular and consistent governance-level reporting and metrics for the Compliance department, including but not limited to dashboards, board reporting, weekly, monthly, and annual compliance & ethics reporting.

  • Reviews 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.

  • Works closely with audited providers to ensure accuracy in the coding and documentation of service.

  • Research compliance related coding questions upon request from departments and/or practices.

  • Identify and report potential audit and compliance risks.

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

  • Diverse and Inclusive culture

  • Generous paid time off with annual roll-over and opportunities to cash out

  • 12 week paid parental leave

ChristianaCare is a not-for-profit teaching health system. 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. Working for ChristianaCare offers the best of urban and suburban living with multiple housing options, excellent restaurants and entertainment venues, quality public and private schools and a short driving distance to popular Delaware and New Jersey beaches. The location provides easy access to Washington, DC, Philadelphia and New York City - all within a short drive or train ride from Newark, DE.

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