Compliance Coding Auditor
Sentara Health
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.
Job description
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
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)
- Associate Level degree preferred but required
Benefits
- Medical, Dental & Vision
- Adoption, Fertility & Surrogacy Reimbursement
- Paid Time Off & Sick Leave
- Paid Parental & Family Caregiver Leave
- Emergency Backup Care
- Long-Term & Short-Term Disability
- Critical Illness Plans
- Life Insurance
- 401(k)/403(b) with Employer Match
- Tuition Assistance
- Student Debt Pay Down
- Pet Insurance
- Legal Resources Plan
- Annual Discretionary Bonus
Company overview
Sentara Health is a leading not-for-profit integrated healthcare delivery system serving Virginia, northeastern North Carolina, and Florida. Founded in 1888 and headquartered in Hampton Roads, Virginia, Sentara operates 12 acute care hospitals across its service area, with 10 hospitals holding prestigious Magnet® recognition for nursing excellence. The organization employs approximately 34,000 healthcare professionals and serves over 1 million health plan members through its Sentara Health Plans division. As one of the top 20 largest not-for-profit integrated health systems in the United States, Sentara is nationally recognized for clinical quality, safety, and innovation. The system has received numerous accolades including Health Quality Innovator of the Year (2024), Forbes' "America's Best-In-State Employer" (2024), and inclusion in IBM Watson Health's "Top 15 Health Systems." Sentara's comprehensive services span hospital care, outpatient facilities, home health, hospice services, and specialized programs like the Nightingale air ambulance service, which has completed over 20,000 missions since 1982.