Compliance Auditor

Christiana Care is searching for a Compliance Auditor to support the Office of Compliance & Privacy through assigned compliance activities and audits to ensure effective clinical documentation that meets regulatory guidelines.

The Compliance Auditor performs a variety of audits to investigate and monitor compliance with federal and state laws, as well as Centers for Medicare and Medicaid Services (CMS) regulations, billing, coding and medical necessity documentation guidelines, and HIPAA Privacy standards. They perform financial, operational and compliance audits for the Office of Compliance & Privacy. Work is diverse and assignments could include a wide array of business areas such as inpatient and outpatient services, physician practices, and contracts.

An individual with clinical/medical necessity expertise is preferred.

The successful candidate must have clinical chart review experience, in addition to broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, and medical necessity criteria.

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

• 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.

Must maintain current CCB certification

• 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

Headquartered in Wilmington, Delaware, Christiana Care 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. Christiana Care 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.

Christiana Care 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…