ChristianaCare is searching for an Auditor to join the Corporate Compliance & Privacy team. The Auditor supports the department through assigned compliance activities and audits to ensure effective documentation. Through communication and training activities, they deliver information or clarification on audit results, compliance inquiries, documentation standards, guidelines, and regulatory requirements. They provide operational, technical, and auditing support for the Office of Compliance & Privacy.
Education and experience requirements:
- Associates Degree required. Bachelor’s Degree preferred.
- Equivalent of 5+ years experience in compliance auditing, clinical chart reviews, privacy auditing, medical necessity review/auditing, revenue integrity, nursing, 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.
Principal duties and responsibilities:
- Helps the Office of Compliance & Privacy adhere to assigned audit schedule and reviews as outlined in the Departmental Compliance Workplan.
- 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.
Special requirements:
Must maintain current CCB certification.
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