Compliance Coding Auditor

City/State

Norfolk, VA

Overview

Work Shift

First (Days) (United States of America)

Sentara Health is seeking to hire a qualified individual to join our team as a Compliance Coding Auditor!

Position Status: Full-time, Day Shift

Position Location: This is a remote position for residents of Virginia or North Carolina.

Position Summary:

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 Manger of Audit and Coding Compliance. Works with leadership regarding scheduling of internal and external audits.

Required:

• CPC or CCS

• 4+ years of experience with multi-specialty coding and acute care outpatient coding

• Professional fee coding experience

Please visit the link below to learn more about Sentara’s commitment to diversity and inclusion:

https://www.sentara.com/aboutus/mission-vision-and-values/diversity.aspx

Sentara Overview

For more than a decade, Modern Healthcare magazine has ranked Sentara Health as one of the nation's top integrated healthcare systems.  That's because we are dedicated to growth, innovation, and patient safety at more than 300 sites of care in Virginia and northeastern North Carolina, including 12 acute care hospitals.

Sentara Benefits

As the third-largest employer in Virginia, Sentara Health was named by Forbes Magazine as one of America's best large employers.  We offer a variety of amenities to our employees, including, but not limited to: 

• Medical, Dental, and Vision Insurance
• Paid Annual Leave, Sick Leave
• Flexible Spending Accounts
• Retirement funds with matching contribution
• Supplemental insurance policies, including legal, Life Insurance and AD&D among others
• Work Perks program including discounted movie and theme park tickets among other great deals
• Opportunities for further advancement within our organization

Sentara employees strive to make our communities healthier places to live. We're setting the standard for medical excellence within a vibrant, creative, and highly productive workplace.  For information about our employee benefits, please visit: Benefits - Sentara (sentaracareers.com)

Join our team! We are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, and growth!

Please Note: The yearly Flu Vaccination is required for employment.

Note: Sentara Health offers employees comprehensive health care and retirement benefits designed with you and your family's well-being in mind. Our benefits packages are designed to change with you by meeting your needs now and anticipating what comes next. You have a variety of options for medical, dental and vision insurance, life insurance, disability, and voluntary benefits as well as Paid Time Off in the form of sick time, vacation time and paid parental leave. Team Members have the opportunity to earn an annual flat amount Bonus payment if established system and employee eligibility criteria is met.

Job Summary

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 Manger of Audit and Coding Compliance. Works with leadership regarding scheduling of internal and external audits.

Associates degree required or 2 years of related experience in lieu of education, plus 4 years of related experience. Required experience must include Ambulatory/Acute Care and Primary Care &/or Specialty Professional Coding. Should have high degree of comfort with technology; possess excellent oral and written communication skills, including basic teaching and presentation skill set; requires a high level of organizational skills, well-developed logical thinking and advanced problem solving skills. New Hire Education Requirement: All Registered Nurses who do not have their BSN will be required to sign a BSN Agreement committing to successfully obtain their BSN within 5 years of hire.

Qualifications:

ALD - Associate's Level Degree

Certified Coding Specialist (CCS) - Certification - American Health Information Management Association (AHIMA), Certified Coding Specialist (CCS) - Certification - American Health Information Management Association (AHIMA), Certified Medical Assistant (CMA) - Certification - American Medical Certification Association (AMCA), Certified Professional Coder (CPC) - Certification - American Academy of Professional Coders (AAPC), Licensed Practical Nurse (LPN) - Nursing License - Other/National, Licensed Practical Nurse (LPN) Single State - Nursing License - Alabama, Licensed Practical Nurse (LPN) Single State - Nursing License - Arizona, Licensed Practical Nurse (LPN) Single State - Nursing License - Arkansas, Licensed Practical Nurse (LPN) Single State - Nursing License - Colorado, Licensed Practical Nurse (LPN) Single State - Nursing License - Delaware, Licensed Practical Nurse (LPN) Single State - Nursing License - Florida, Licensed Practical Nurse (LPN) Single State - Nursing License - Idaho, Licensed Practical Nurse (LPN) Single State - Nursing License - Indiana, Licensed Practical Nurse (LPN) Single State - Nursing License - Iowa, Licensed Practical Nurse (LPN) Single State - Nursing License - Kansas, Licensed Practical Nurse (LPN) Single State - Nursing License - Kentucky, Licensed Practical Nurse (LPN) Single State - Nursing License - Louisiana, Licensed Practical Nurse (LPN) Single State - Nursing License - Maine, Licensed Practical Nurse (LPN) Single State - Nursing License - Maryland, Licensed Practical Nurse (LPN) Single State - Nursing License - Mississippi, Licensed Practical Nurse (LPN) Single State - Nursing License - Missouri, Licensed Practical Nurse (LPN) Single State - Nursing License - Montana, Licensed Practical Nurse (LPN) Single State - Nursing License - Nebraska, Licensed Practical Nurse (LPN) Single State - Nursing License - New Hampshire, Licensed Practical Nurse (LPN) Single State - Nursing License - New Jersey {+ 48 more}

Acute Care, Coding

Skills

Communication, Complex Problem Solving, Critical Thinking, Technology/Computer

Sentara Healthcare 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.

Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.

In support of our mission “to improve health every day,” this is a tobacco-free environment.