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

Sentara is currently reviewing market compensation for this role. Our Talent Acquisition team will be able to share more specific information during the recruiting process.