Director, Coding and Billing Compliance

ChristianaCare is one of the country's most dynamic healthcare organizations, centered on improving health outcomes, making high-quality care more accessible, and lowering healthcare costs. ChristianaCare includes an extensive network of outpatient services, home health care, urgent care centers, three hospitals (1,299 beds), a free-standing emergency department, 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. It also includes the pioneering Gene Editing Institute and was rated by IDG Computerworld as one of the nation's Best Places to Work in IT. ChristianaCare is a nonprofit teaching health system with more than 260 residents and fellows. It is continually ranked by U.S. News & World Report as the Best Hospital. With the unique CareVio data-powered care coordination service and a focus on population health and value-based care, ChristianaCare is shaping the future of health care.

ChristianaCare Offers

• Full Medical, Dental, Vision, Life Insurance, etc.
• Two retirement planning offerings, including 403(b) with company contributions
• Generous paid time off with annual roll-over and opportunities to cash out
• 12-week paid parental leave
• Incredible Work/Life benefits including annual membership to care.com, access to backup care services for dependents through Care@Work, retirement planning services, financial coaching, fitness and wellness reimbursement, and great discounts through several vendors for hotels, rental cars, theme parks, shows, sporting events, movie tickets and much more!

About This Position

Under the direction of the Chief Compliance Officer, the Director of Coding and Billing Compliance will be responsible for the oversight, development, and management of the Coding and Billing Compliance Program focused on revenue cycle, billing, coding, reimbursement, charging, documentation, medical necessity, government payer requirements, and revenue-related regulatory compliance. The Director serves as the Department's subject matter expert on coding and billing compliance and will be responsible for supporting organizational compliance with federal and state healthcare program requirements.

Principle Duties and Responsibilities

• Develop and maintain an enterprise-wide Coding and Billing Compliance Program aligned with organizational compliance objectives and regulatory expectations.
• Conduct ongoing coding and billing compliance risk assessments and develop annual risk-based audit and monitoring plans.
• Monitor regulatory and enforcement developments to identify emerging reimbursement, billing, coding, documentation, medical necessity, and revenue cycle compliance risks, and provide guidance to support organizational compliance.
• Design and oversee auditing and monitoring activities to evaluate compliance with Medicare, Medicaid, commercial payer, and organizational requirements.
• Direct investigations involving billing, coding, reimbursement, charging, documentation, or other revenue cycle compliance concerns.
• Lead root-cause analysis and corrective action planning related to audit findings, investigations, overpayments, repayment obligations, and identified compliance vulnerabilities.
• Develop compliance reporting and dashboards that provide meaningful insights into revenue integrity risks, trends, audit outcomes, corrective actions, and program effectiveness.
• Partner with Revenue Cycle, Finance, HIMS, CDI, and operational leaders to strengthen internal controls and mitigate compliance risks.
• Oversee compliance education and communication initiatives, including targeted training for leadership, providers, and revenue cycle personnel.
• Prepare reports and presentations for executive leadership, management committees, and other governance bodies regarding significant compliance risks, trends, and program activities.
• Manage and develop Coding and Billing Compliance staff, including performance management, professional development, and workload prioritization.

Minimum Education and Experience Requirements

• Bachelor's degree required; Master's degree preferred.
• Minimum ten (10) years of healthcare experience in revenue cycle, revenue integrity, reimbursement, coding and billing compliance, healthcare compliance, internal audit, or related healthcare financial operations.
• Minimum five (5) years of progressive leadership experience.
• Demonstrated experience developing or overseeing compliance auditing, monitoring, investigations, risk assessments, and corrective action processes.
• Experience within large hospitals, health systems, or integrated delivery networks preferred.
• Preferred experience with Epic electronic health record (EHR) systems in a hospital environment

Special Requirements

One or more of the following certifications preferred:

• Certified in Healthcare Compliance (CHC)
• Certified Professional Medical Auditor (CPMA)
• Certified Professional Coder (CPC)
• Certified Coding Specialist (CCS/CCS-P)
• Registered Health Information Administrator (RHIA)
• Certified Healthcare Financial Professional (CHFP)
• Certified Revenue Cycle Representative (CRCR)

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.

Post End Date

EEO Posting Statement

ChristianaCare offers a competitive suite of employee benefits to maximize the wellness of you and your family, including health insurance, paid time off, retirement, an employee assistance program. To learn more about our benefits for eligible positions visithttps://careers.christianacare.org/benefits-compensation/