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.
Associate's Level Degree - Experience in lieu of education: Yes
Required: Acute Care - 4 years, Coding - 4 years
Required: Cert Coding Specialist, Cert Professional Coder
Preferred: Cert Medical Assistant, Licensed Practical Nurse, Registered Nurse
Sentara Medical Group is hiring a Compliance Coding Auditor-Consolidated Billing, Norfolk!
Shift: Full Time/days
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.