Compliance Coding Auditor

Sentara; Norfolk (VA); Hybrid; USD 47,000 - 70,000; Full time

Benefits offered by this job

Medical, Dental, Vision

401(k)/403(b) with employer match

Paid time off

Tuition assistance

Life and disability insurance

Employee bonus opportunity

Job summary

Sentara Health in Norfolk, VA seeks a Compliance Coding Auditor to conduct internal and external coding audits, educate coders and physicians, and improve compliance with payer policies. The role covers ICD/CPT coding methodologies and requires mastery of CCI, NCD, HCC, and MPFS concepts.

Remote options may be available for eligible candidates in the region. The ideal candidate has an Associate degree or higher, CPC or CCS certification, and 4+ years of multi-specialty/outpatient coding

Qualifications

• Associate degree required or higher in health information management or related field.
• CPC or CCS certification required.
• 4+ years of multi-specialty coding experience.
• 4+ years of acute care outpatient coding experience.

Responsibilities

• Perform internal audits to ensure compliant coding practices.
• Educate coders and physicians on coding guidelines and policies.
• Manage AR queries and coordinate responses to external auditors.
• Identify coding trends and advise audit leadership on process improvements.
• Schedule and coordinate internal and external audits as needed.

Skills

Attention to detail

Communication

Problem solving

Time management

Education

Associate Degree in Health Information Management

CPC or CCS certification

Tools

EHR systems

MS Excel

Job description

City/StateNorfolk, VAWork ShiftFirst (Days)Overview:Compliance Coding AuditorPerforms 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.EducationAssociate Level degree preferred but requiredCertification/LicensureCPC or CCS certification (Required)Experience4+ years of experience with multi-specialty coding (Required)4+ years of experience with acute care outpatient coding (Required)Professional fee coding experience (Required)Remote work opportunity preferred candidates in the Virginia/North Carolina geographic locationWe provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay range for full-time employment is $34.28 - $50.80 hourly. Additional compensation may be available for this role, such as shift differentials, on-call pay, overtime, shift premiums, extra-shift incentives, or bonus opportunities. Compensation within the range may vary based on qualifications, experience, location, market conditions, and business needs. Sentara offers a comprehensive benefits package, including medical, dental, vision, life and disability insurance; 401(k)/403(b) with employer match; paid time off (vacation, sick time, and holidays); paid parental and military leave; educational assistance or student loan repayment; and voluntary benefits.Benefits: Caring For Your Family and Your Career• Medical, Dental, Vision plans• Adoption, Fertility and Surrogacy Reimbursement up to $10,000• Paid Time Off and Sick Leave• Paid Parental & Family Caregiver Leave• Emergency Backup Care• Long-Term, Short-Term Disability, and Critical Illness plans• Life Insurance• 401k/403B with Employer Match• Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education• 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.