Compliance Coding Auditor

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

Benefits offered by this job

Medical, Dental, Vision plans

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

Paid time off

Educational assistance or student loan

Life Insurance

Disability insurance

Job summary

Sentara Health Plans is seeking a Compliance Coding Auditor to perform internal audits of ICD and CPT coding, educate coders, and liaise with external auditors. The role emphasizes mastery of CCI, NCD, and HCC policies, with attention to MPFS RVU impacts for NPP services, and remote work opportunities for candidates in Virginia or North Carolina.

The position requires CPC or CCS certification, 4+ years of multi-specialty and acute care outpatient coding experience, and professional fee coding

Qualifications

• 4+ years of experience with multi-specialty coding.
• 4+ years of experience with acute care outpatient coding.
• Professional fee coding experience.
• Associate level degree preferred but required.
• CPC or CCS certification required.

Responsibilities

• Follows audit plan, completing numerous audits and providing follow-up to coders, management, and physicians.
• Looks for new problem areas and advises Manager of Audit and Coding Compliance.
• Works with leadership regarding scheduling of internal and external audits.

Skills

Multi-specialty coding

Acute care outpatient coding

Professional fee coding

Education

Associate degree

CPC or CCS certification

Job description

**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.Education* Associate Level degree preferred but requiredCertification/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.