Compliance Coding Auditor

Overview

A healthcare organization is seeking a Compliance Coding Auditor to perform physician education, internal auditing, coder education, management of accounts receivable queries/problems, and act as a liaison with external auditors during corporate audits. The internal audit program ensures ethical reimbursement practices and compliance with established coding guidelines.

The role involves using both ICD and CPT coding methodologies. The auditor must demonstrate competence in Correct Coding Initiative (CCI), National Coverage Determination (NCD), Hierarchical Conditionals Categories (HCC), and other federal payer policies. Mastery of the Medicare Physician Fee Schedule (MPFS) payment methodology, including understanding the impact on Relative Value Unit (RVU) values related to Non-Physician Practitioner (NPP) services, Provider Based Billing (PBB) locations, and other complex coding protocols, is expected within one year.

All queries arising from the audit process are managed by the Compliance Auditor. The auditor follows the audit plan, completes numerous audits, and provides follow-up to coders, management, and physicians. The role includes identifying new problem areas and trends and advising the Manager of Audit and Coding Compliance. Coordination with leadership regarding scheduling of internal and external audits is also required.

Location and Work Shift

• Location: Norfolk, VA
• Work Shift: First (Days)
• Remote work opportunity preferred for candidates in the Virginia/North Carolina geographic area

Responsibilities

• Conduct internal audits using ICD and CPT coding methodologies
• Educate physicians and coders on compliance and coding practices
• Manage accounts receivable queries and problems
• Liaise with external auditors during corporate audits
• Ensure coding practices comply with established guidelines
• Identify trends and problem areas in coding and compliance
• Advise management on audit findings and compliance issues
• Coordinate scheduling of internal and external audits

Requirements

• Associate degree preferred but required
• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification (Required)
• Minimum of 4 years of experience with multi-specialty coding (Required)
• Minimum of 4 years of experience with acute care outpatient coding (Required)
• Professional fee coding experience (Required)

Compensation and Benefits

• Medical, Dental, and Vision insurance plans
• Adoption, Fertility, and Surrogacy Reimbursement up to $10,000
• Paid Time Off and Sick Leave
• Paid Parental and Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness insurance plans
• Life Insurance
• 401k/403B retirement plans with employer match
• Tuition Assistance up to $5,250 per year and discounted educational opportunities
• Student Debt Pay Down up to $10,000
• Reimbursement for certifications and free access to continuing education units (CEUs) and professional development
• Pet Insurance
• Legal Resources Plan
• Eligibility for an annual discretionary bonus based on system and employee criteria

Equal Opportunity and Work Environment

The organization is an equal opportunity employer committed to diversity, inclusion, and belonging. The workforce reflects the communities served. This is a tobacco-free environment.

Remote Work Eligibility

For remote positions, associates may be employed in the following states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.