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ChristianaCare · 2 days ago

Compliance Auditor

Wilmington, DE

Full-time

Onsite

Mid, Senior Level

$68K/yr - $109K/yr

5+ years exp

ChristianaCare is a dynamic health system headquartered in Wilmington, Delaware, focused on improving health outcomes and making high-quality care accessible. The Compliance Auditor will support the Office of Compliance & Privacy by performing audits to ensure adherence to regulatory guidelines and compliance with laws related to clinical documentation, billing, and coding.

Health CareHospitalNon Profit

Responsibilities

Helps the Office of Compliance & Privacy adhere to assigned audit schedule and reviews as outlined in the Departmental Compliance Workplan and as assigned

Assists with reviewing internal and external inquiries regarding compliance and privacy matters, including government and third-party payor requests

Conducts 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 facility-based and provider-based clinical documentation and medical necessity

Maintain a working knowledge of HIPAA and CMS regulations

Participate in the planning and scheduling of compliance projects

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

Identify and report potential audit and compliance risks

Qualification

Clinical chart reviewCompliance auditingMedical necessity reviewHealthcare Compliance CertificationCMS regulations knowledgePayer reimbursement policiesAnalytical skillsCompliancePrivacy auditingCommunication skills

Required

Bachelor's Degree is required

Equivalent of 5+ years' experience in nursing, compliance auditing, clinical chart reviews, medical necessity review/auditing, revenue integrity, and/or compliance department operations/regulations

Certification (at least one of the following are required and are to be maintained as a condition of employment): Certified in Healthcare Compliance (CHC); Certified in Healthcare Privacy Compliance (CHPC)

In-depth knowledge of compliance and privacy regulations

Must be proficient in CMS Conditions of Participation, CMS Conditions of Payment, and Inpatient and Outpatient Prospective Payment System

Strong analytical and communication skills

Candidates who do not hold a CHC will be given consideration but will need to obtain the CHC within 2 years of their hire date with the company

Must maintain current CCB certification

Preferred

An individual with clinical/medical necessity expertise is preferred

Experience in compliance and privacy auditing techniques and methods preferred, but not required

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

Health insurance

Paid time off

Retirement

An employee assistance program

Company

ChristianaCare

Glassdoor3.5

Headquartered in Wilmington, Delaware, ChristianaCare is one of the country’s most dynamic health care organizations, centered on improving health outcomes, making high-quality care more accessible and lowering health care costs.

Founded in 1888

Wilmington, Delaware, USA

10001+ employees