[Hiring] Compliance Coding Auditor @Sentara Health

Role Description

The Compliance Coding Auditor performs a number of functions including:

• Physician education
• Internal auditing
• Coder education
• Management of AR queries/problems
• Liaison with external auditors for corporate audits

The internal audit program assures optimal ethical reimbursement for Sentara's patients and ensures 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 Condition Categories (HCC)
• Other federal payer policies

The Auditor 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
• All other complex coding protocols within one year

All queries arising from the audit process are managed by the Compliance Auditor, who:

• Follows the audit plan
• Completes numerous audits
• Provides follow-up to coders, management, and physicians
• Looks for new problem areas and trends
• Advises Manager of Audit and Coding Compliance
• Works with leadership regarding scheduling of internal and external audits

Qualifications

• Associate Level 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)
• Remote work opportunity preferred for candidates in the Virginia/North Carolina geographic location

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
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria are met