Compliance Coding Auditor

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

Benefits offered by this job

Medical, Dental, Vision plans

401k/403B with employer match

Paid Time Off and Holidays

Educational assistance

Job summary

Sentara Health in Norfolk, VA is seeking a Compliance Coding Auditor to support internal audits, physician education, and coding education. You will work with ICD/CPT coding, CCI, NCD, and HCC concepts to ensure compliance and accurate reimbursements.

The position requires 4+ years in multi-specialty and acute care outpatient coding, CPC or CCS certification, and offers a first-shift schedule with remote work options for VA/NC candidates.

Qualifications

• 4+ years of multi-specialty coding experience.
• 4+ years of acute care outpatient coding experience.
• Professional fee coding experience.
• CPC or CCS certification required.

Responsibilities

• Perform internal audits of coding practices.
• Educate physicians and coders; liaise with external auditors as needed.
• Manage AR queries and follow up with management and physicians.

Skills

CCI knowledge

NCD knowledge

HCC knowledge

Auditing

Compliance

Education

Associate degree

CPC or CCS certification

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

• 4+ 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 location

We 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.