Compliance Coding Auditor
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At a glance
Requirements
Credentials this posting asks for.
Job overview
Sentara Health is hiring a Compliance Coding Auditor. The Compliance Coding Auditor performs physician and coder education, internal auditing, manages AR queries, and liaises with external auditors to ensure ethical reimbursement and coding compliance. The role utilizes ICD and CPT methodologies, audits coding practices, and advises management on problem areas and trends.
Key focus areas include Perform internal audits of coding practices, Educate physicians and coders on compliance guidelines, and Manage AR queries and problems.
Important skills include ICD Coding, CPT Coding, Correct Coding Initiative, National Coverage Determination, Hierarchical Condition Categories, and MPFS Payment Methodology.
Skills & qualifications
Skills
Qualifications
Benefits
Full job description
City/State
Norfolk, VA
Work Shift
First (Days)
Overview:
Compliance Coding Auditor
Performs a number of functions including those of physician education, internal auditing, coder education, management of AR queries/problems, and liaison with external auditors for corporate audits. The internal audit program assures optimal ethical reimbursement for Sentara's patients, and also assures that the coding practices fall within established compliance guidelines.
Both ICD and CPT coding methodologies are used in the internal audit activity. The Auditor must exhibit competence in Correct Coding Initiative (CCI), National Coverage Determination (NCD), Hierarchical Conditionals Categories (HCC) and other federal payer policies, and is expected to achieve mastery in the MPFS payment methodology, including the impact on Relative Value Unit (RVU) value related to Non-Physician Practitioner (NPP) services, Provider Based Billing (PBB) locations, and all other complex coding protocols within one year.
All queries arising from the audit process are managed by the Compliance Auditor. Follows audit plan, completing numerous audits and providing follow-up to coders, management, and physicians. Looks for new problem areas, trends, etc., and advises Manager of Audit and Coding Compliance. Works with leadership regarding scheduling of internal and external audits.
Education
- Associate Level degree preferred but required
Certification/Licensure
- CPC or CCS certification (Required)
Experience
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4+ years of experience with multi-specialty coding (Required)
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4+ years of experience with acute care outpatient coding (Required)
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Professional fee coding experience (Required)
Remote work opportunity preferred candidates in the Virginia/North Carolina geographic location
Benefits: Caring For Your Family and Your Career
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Medical, Dental, Vision plans
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Adoption, Fertility and Surrogacy Reimbursement up to $10,000
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Paid Time Off and Sick Leave
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Paid Parental & Family Caregiver Leave
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Emergency Backup Care
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Long-Term, Short-Term Disability, and Critical Illness plans
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Life Insurance
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401k/403B with Employer Match
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Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
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Student Debt Pay Down – $10,000
•Pet Insurance •Legal Resources Plan •Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
In support of our mission “to improve health every day,” this is a tobacco-free environment.
For positions that are available as remote work, Sentara Health employs associates in the following states:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.
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