Compliance Coding Auditor

Sentara Health•Norfolk, VA

1d•Remote

About The Position

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.

Requirements

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)
Competence in Correct Coding Initiative (CCI), National Coverage Determination (NCD), Hierarchical Conditionals Categories (HCC) and other federal payer policies.
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.

Nice To Haves

Associate Level degree preferred
Remote work opportunity preferred candidates in the Virginia/North Carolina geographic location

Responsibilities

Performs physician education, internal auditing, coder education, management of AR queries/problems, and liaison with external auditors for corporate audits.
Assures optimal ethical reimbursement for Sentara's patients and that coding practices fall within established compliance guidelines.
Manages all queries arising from the audit process.
Follows audit plan, completing numerous audits and providing follow-up to coders, management, and physicians.
Identifies new problem areas, trends, etc., and advises Manager of Audit and Coding Compliance.
Works with leadership regarding scheduling of internal and external audits.

Benefits

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
Reimbursement for certifications and free access to complete CEUs and professional development
Pet Insurance
Legal Resources Plan
Annual discretionary bonus if established system and employee eligibility criteria is met.