Compliance Coding Auditor

Sentara Health; United States; On-site; USD 47,000 - 70,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

401k with employer match

Tuition Assistance

Job summary

Sentara Health in Norfolk, VA seeks a Compliance Coding Auditor to support physician education, internal auditing, coder education, and AR query management. Strong knowledge of ICD/CPT, CCI, NCD, and HCC is required, with a focus on MPFS impact.

Qualifications include an Associate Degree (preferred but required), CPC or CCS certification, 4+ years in multi-specialty and acute care outpatient coding, and professional fee coding experience. Remote work is possible for VA/NC candidates.

Qualifications

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

Responsibilities

• Follows audit plan and completes audits with follow-up to coders, management, and physicians.
• Identifies new problem areas and advises Audit and Coding Compliance leadership.
• Works with leadership on scheduling internal and external audits.

Skills

Healthcare coding

CPC/CCS certification

Multi-specialty coding

Acute care outpatient coding

Compliance auditing

Education

Associate Degree

CPC/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.

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. Sentara Health is a Virginia and Northeastern North Carolina based not-for-profit integrated healthcare provider that has been in business for over 131 years. Offering hundreds of sites of care including 12 hospitals, PACE, home health, hospice, medical groups, imaging services, therapy, outpatient surgery centers, and an 858,000 member health plan. The people of the communities that we serve have nominated Sentara “Employer of Choice” for over ten years. U.S. News and World Report has recognized Sentara as having the Best Hospitals for 15+ years. Sentara offers professional development and a continued employment philosophy!