Compliance Coding Auditor

Sentara Health Plans; Norfolk, Northern (VA, KY); Hybrid; USD 80,000 - 110,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

Paid Time Off

Tuition Assistance

401k/403B with Employer Match

Pet Insurance

Job summary

Sentara Health Plans in Norfolk, VA, is seeking a Compliance Coding Auditor to perform internal coding audits, physician education, and AR query management. The role requires expertise in CCI, NCD, and HCC guidelines, and mastery of MPFS impact on RVU for NPP services. Remote work is favored for VA/NC candidates.

Ideal candidates have CPC/CCS certification and 4+ years of multi-specialty coding experience, including acute care outpatient coding and professional fee coding.

Qualifications

• Associate degree required or preferred.
• CPC or CCS certification required.
• 4+ years of multi-specialty coding experience.
• 4+ years of acute care outpatient coding experience.
• Professional fee coding experience.
• Remote work opportunity for candidates in Virginia/North Carolina.

Responsibilities

• Perform internal coding audits and physician education.
• Manage AR queries and problems.
• Liaise with external auditors for corporate audits.
• Follow the audit plan and provide follow-up to coders, management, and physicians.
• Identify problem areas and advise Manager of Audit and Coding Compliance.
• Coordinate scheduling of internal and external audits.

Skills

Multi-specialty coding

Acute care outpatient coding

Professional fee coding

Regulatory compliance

Auditing

Education

Associate degree

CPC/CCS certification

Job description

## Compliance Coding AuditorApplyremote type: Remotelocations: Norfolk, VAtime type: Full timeposted on: Posted Yesterdayjob requisition id: JR-104491**City/State**Norfolk, VA**Work Shift**First (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.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*** **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.