Compliance Coding Auditor

sentara; Norfolk (VA); Hybrid; USD 81,036,000 - 115,415,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

401k/403B with Employer Match

Tuition Assistance - $5,250/year

Student Debt Pay Down - $10,000

Pet Insurance

Legal Resources Plan

Annual discretionary bonus

Job summary

Sentara Health in Norfolk, VA is seeking a Compliance Coding Auditor to conduct multi-specialty coding audits and ensure ethical reimbursement. The role requires CCI, NCD, and HCC knowledge, plus 4+ years in coding across various settings.

The position emphasizes education, audit follow-up, and collaboration with leadership. The role supports remote work options for qualified Virginia/North Carolina candidates, with base compensation described in the posted pay range.

Qualifications

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

Responsibilities

• Perform compliance coding audits and partner with physicians to ensure accurate coding
• Educate physicians and coders to improve coding accuracy and compliance
• Manage AR queries/problems and liaise with external auditors for corporate audits
• Follow audit plan and provide timely follow-up to coders, management and physicians
• Identify new problem areas and advise the Audit and Coding Compliance Manager
• Coordinate with leadership regarding scheduling internal and external audits

Skills

CCI knowledge

NCD knowledge

HCC knowledge

Education

Associate level degree

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

Salary and Compensation

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, standby/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.

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.