Healthcare Compliance Specialist

1 week ago


Wilmington, Delaware, United States ChristianaCare Full time
Job Description

We are seeking a skilled Healthcare Compliance Specialist to join our team at ChristianaCare, one of the top 100 hospitals in the nation.

About the Role

The Compliance Coding Auditor supports the department through assigned auditing activities to ensure effective documentation, accurate coding, and billing compliance. This role requires strong analytical and communication skills, as well as experience with medical claims' billing/payment systems, provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology.

Responsibilities
  • Assist with reviewing internal and external inquiries regarding professional and hospital/clinical billing compliance matters
  • Provide support for provider, hospital/clinical billing and coding audits and focused reviews
  • Maintain regular and consistent governance-level reporting and metrics for the Compliance department
  • Review documentation to ensure appropriate assignment of DRG, ICD-9 codes, CPT codes, and modifiers
  • Participate in planning and scheduling of compliance projects
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: CPMA, CPC, CCS, CIC)
  • In-depth knowledge of ICD CM, ICD PCS, and CPT/HCPCS coding systems
Benefits
  • 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
Location

ChristianaCare offers a unique blend of urban and suburban living, with easy access to Washington, DC, Philadelphia, and New York City.

This position offers a competitive salary range of $80,000 - $110,000 per year, depending on experience.



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