Compliance Coding Auditor

Sentara Health•Norfolk, VA

2d•$34 - $51•Remote

About The Position

The Compliance Coding Auditor performs physician education, internal auditing, coder education, management of accounts receivable (AR) queries and problems, and serves as a liaison with external auditors for corporate audits. The internal audit program supports ethical reimbursement for patients and ensures coding practices comply with established guidelines. The role uses ICD and CPT coding methodologies. The auditor is expected to demonstrate competence in the Correct Coding Initiative (CCI), National Coverage Determination (NCD), Hierarchical Condition Categories (HCC), and other federal payer policies. Within one year, the auditor is expected to achieve mastery of the Medicare Physician Fee Schedule (MPFS) payment methodology, including the impact on Relative Value Unit (RVU) values related to Non-Physician Practitioner (NPP) services, Provider Based Billing (PBB) locations, and other complex coding protocols. The auditor manages queries arising from the audit process, follows the audit plan, completes audits, and provides follow-up to coders, management, and physicians. The role identifies emerging problem areas and trends, advises the Manager of Audit and Coding Compliance, and works with leadership to schedule internal and external audits. Remote work is offered, with preference for candidates in Virginia or North Carolina.

Requirements

CPC or CCS certification is required.
At least 4 years of experience with multi-specialty coding is required.
At least 4 years of experience with acute care outpatient coding is required.
Professional fee coding experience is required.
Competence in ICD and CPT coding methodologies, CCI, NCD, HCC, and other federal payer policies is expected.
Achieve mastery within one year in MPFS payment methodology, including RVU impacts related to NPP services, PBB locations, and other complex coding protocols.

Nice To Haves

Associate-level degree (listed as preferred but required in the posting).
Remote-work candidates in Virginia or North Carolina are preferred.

Responsibilities

Perform physician education, internal auditing, and coder education.
Manage accounts receivable queries and problems arising from the audit process.
Liaise with external auditors for corporate audits.
Follow the audit plan and complete audits.
Provide audit follow-up to coders, management, and physicians.
Identify new problem areas and trends and advise the Manager of Audit and Coding Compliance.
Work with leadership to schedule internal and external audits.
Support ethical reimbursement and ensure coding practices comply with established guidelines.

Benefits

Medical, dental, and vision plans.
Adoption, fertility, and surrogacy reimbursement up to $10,000.
Paid time off and sick leave.
Paid parental and family caregiver leave.
Emergency backup care.
Long-term and short-term disability and critical illness plans.
Life insurance.
401(k)/403(b) with employer match.
Tuition assistance up to $5,250 per year and discounted educational opportunities through Guild Education.
Student debt pay down up to $10,000.
Pet insurance.
Legal resources plan.
Opportunity to earn an annual discretionary bonus if system and employee eligibility criteria are met.
Market-competitive compensation including base pay, incentives, and benefits; additional compensation may include shift differentials, on-call pay, overtime, shift premiums, extra-shift incentives, or bonuses.