The U.S. Department of Homeland Security recently issued an emergency advisory about an elevated threat of cybersecurity attacks targeting hospitals and health care systems in the U.S. These threats can come by phone calls, text messages or emails.
ChristianaCare advises that everyone be alert to potential phone, email and text-messaging scams. If you receive a suspicious phone call, text message or email from ChristianaCare that asks you to make a financial transaction or to provide personal information, please visit www.christianacare.org or call 302-327-5555 and ask to speak to someone from the department or service that contacted you.
To oversee the daily activities of the Medical Audit Department. Uses knowledge of revenue cycle principles to ensure accurate and compliant billing while playing a key role in the clinical support of the hospital/physician chargemaster.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
Provides overall management and direction of daily duties related to auditing, pre-bill editing, charging, education, training and compliance controls.
Monitors efficiency and effectiveness of each function that occurs within the department.
Identifies, researches, and analyzes billing errors and/or omissions.
Prepares and revises policies and procedures as warranted, conducts in-service/meetings with caregivers. Monitors caregiver's productivity and performance.
Safeguards the integrity of billed accounts by ensuring compliance with billing, documentation and coding standards.
Implements various strategic initiatives measuring the effectiveness and efficiency of on-going procedures and coordinating procedural changes.
Responds to all inquiries, issues, concerns as related to the Medical Audit Department
Uses clinical knowledge to evaluate the appropriateness of a service or proposed code.
Uses clinical and coding knowledge in overseeing chart audits for compliance, accuracy, completeness, and charge capture. Prepares reports and action plans as needed. Consults with fellow managers and staff regarding identification of billing and reimbursement issues.
Oversees the audits of patient bills against the medical record, determining accuracy, making changes as necessary and providing corrective intervention to reduce further occurrences. Files appeals as needed.
Oversees insurance defense and concurrent audits by reviewing the patient medical record and the itemized statement, analyzing discrepancies to ensure charges reflect adherence to physician orders, hospital policy, and accuracy of items and services received.
Provides support as requested to Billing, Admissions, Customer Service and Ancillary Departments, by researching and reviewing third-party payor problems and issues for clarification and equitable resolution of charges and services rendered.
Assists in the development of annual departmental goals and objectives.
Attends, participates and conducts departmental staff and management staff meetings.
Maintains comprehensive knowledge of regulatory requirements related to third party billing rules.
Complies with the approved budget.
Adheres to established departmental safety rules and practices and reviews routinely with staff.
Performs other duties, as required.
EDUCATION AND EXPERIENCE REQUIREMENTS:
At least five years of experience in a clinical/coding position with leadership responsibilities
Internal Number: JR54434
About Christiana Care Health System
Christiana Care Health System is headquartered in Wilmington, Delaware and is one of the country's largest health care providers, ranking 21st in the nation for hospital admissions. Christiana Care is proudly a Nurse Magnet recognized institution. Christiana Care Health System is also one of the largest health care providers in the mid-Atlantic region, serving all of Delaware and portions of seven counties bordering the state in Pennsylvania, Maryland and New Jersey. A not-for-profit, non-sectarian health system, Christiana Care includes two hospitals with more than 1,100 patient beds, and is a major teaching hospital with two campuses. Christiana Care is continually recognized for excellence on a regional and national level. Our role in the community is expressed in the Christiana Care Way: "We serve our neighbors as respectful, expert, caring partners in their health. We do this by creating innovative, effective, affordable systems of care that our neighbors value."Christiana Care is a great place to work because we value diversity and recognize it to be a core part of our success. Because of the diversity of our employees, affiliated health professionals and volunteers, we are... positioned to meet the unique needs of our patients and community. We acknowledge and celebrate the uniqueness and talent of each employee. Because of our talented workforce we are able to provide a quality healthcare experience to our patients and community. We strive to create an inclusive environment in which individual diversity can be leveraged and thrive. Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.