Coding Compliance Auditor, Health System, Days, CPC req. (Billing)
Nemours - Wilmington, DE

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Nemours is seeking a Coding Compliance Auditor to join our team in Delaware.

As one of the nation’s premier pediatric health care systems, Nemours provides world-class clinical care in four states: Delaware, Florida, New Jersey and Pennsylvania. Located in Wilmington, Delaware, the Nemours/Alfred I. duPont Hospital for Children offers intensive and acute inpatient and outpatient services covering more than 30 pediatric specialties. Ranked among the nation’s best in pediatric specialty care by U.S. News & World Report , this world-renowned teaching hospital has served children from 42 states and 14 nations. Extending the world-class care of the Nemours/Alfred I. duPont Hospital, the Nemours Children’s Clinic provides expert care for even more children across the Delaware Valley through community-based physician services and collaborative partnerships with health and hospital systems.

To keep pace with the changing health care environment and build a healthier future for our children, Nemours has embarked on a multi-phase expansion to create a children’s hospital like no other in the region. Upon completion in June 2014, the hospital will include private, family-centered, technologically advanced patient rooms, a new Pediatric Intensive Care Unit and a new expanded Emergency Department.

This position is responsible for conducting medical record reviews of the coding and documentation of diagnoses, medical procedures and patient encounters by Nemours clinical services providers (physicians and billing providers), as requested by the Coding and Billing Compliance Director. The coding compliance auditor will also meet with clinical services providers to discuss their compliance reviews and present continuing education, as necessary. This position will also work on special projects individually or in collaboration with other coding auditors, as requested, including providing training and education to Nemours clinical services providers and coding and billing personnel on coding and billing rules and regulations.

  • Conduct medical record reviews of the coding and documentation of diagnoses and medical procedures and patient encounters by clinical services providers at Nemours’ Delaware, Pennsylvania and New Jersey sites or as requested by the Coding and Billing Compliance Director.
  • Conduct educational sessions for clinical services providers and coding and billing personnel on coding and billing rules and regulations; and monitor and review processes, as requested.
  • Work closely with coding and billing staff at each site to ensure compliance with Nemours policies and third-party payer coding guidelines.
  • Monitor and communicate additions and/or revisions to coding and documentation rules and regulations. Assist in development of system-wide coding and billing policies.
  • Participate in planning sessions with the Coding and Billing Compliance Director to develop clinical services provider coding review schedule based on clinical service providers’ historical coding accuracy and organizational needs.
  • Prepare reports as required relative to monitoring and review activities.
  • Perform other duties as requested by Compliance management.
  • Periodically monitor and report on the coding interfaces associated with the Nemours Electronic Medical Record System (Epic).

  • Additional Responsibilities
  • Assist the Coding and Billing Director with the coordination and standardization of coding principles among Nemours providers.
  • Assist in all disputes regarding provider billing, coding or documentation issues.
  • Attend compliance staff meetings.

  • Requirements
  • Must be a certified professional coder (CPC) through the American Academy of Professional Coders.
  • Minimum five years hands-on experience in physician coding.
  • Thorough knowledge of CMS’ coding and documentation guidelines.
  • Knowledge of third-party physician service coding and billing practices.
  • Pediatric coding experience preferred.
  • Must be able to work independently.
  • Ability to communicate effectively with physicians and administrative staff.
  • Excellent written communication skills.
  • Highly organized and project-oriented.
  • Ability to manage multiple priorities.
  • Presentation skills (individual and group setting).

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    As an equal opportunity employer, Nemours is committed to focusing on the best-qualified applicants for our openings.

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    Nemours is committed to improving the health of children. As a non-profit children’s health organization, we consider the health of...