Sentara Health Plans

## Compliance Coding AuditorApplyremote type: Remotelocations: Norfolk, VAtime type: Full timeposted on: Posted Yesterdayjob requisition id: JR-104491**City/State**Norfolk, VA**Work Shift**First (Days)**Overview:**# Compliance Coding AuditorPerforms 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...

Sentara Health Plans in Norfolk, VA, is seeking a Compliance Coding Auditor to perform internal coding audits, physician education, and AR query management. The role requires expertise in CCI, NCD, and HCC guidelines, and mastery of MPFS impact on RVU for NPP services. Remote work is favored for VA/NC candidates. Ideal candidates have CPC/CCS certification and 4+ years of multi-specialty coding experience, including acute care outpatient coding and professional fee coding. #J-18808-Ljbffr

Sentara Health Plans in Norfolk, VA, is seeking a Compliance Coding Auditor to perform internal coding audits, physician education, and AR query management. The role requires expertise in CCI, NCD, and HCC guidelines, and mastery of MPFS impact on RVU for NPP services. Remote work is favored for VA/NC candidates. Ideal candidates have CPC/CCS certification and 4+ years of multi-specialty coding experience, including acute care outpatient coding and professional fee coding. #J-18808-Ljbffr

## Risk Adjustment CoderApplyremote type: Hybridlocations: SMG Administrationtime type: Full timeposted on: Posted Todayjob requisition id: JR-103351**City/State**Virginia Beach, VA**Work Shift**First (Days)**Overview:**# **Overview**Performs compliance activities focused on risk adjustment in accordance with Centers for Medicare & Medicaid Services (CMS) and U.S. Department of Health & Human Services (HHS). Performs prospective/retrospective medical record reviews (MMR) & CMS/HHS Risk Adjustment Data Validation (RADV) audits. Reviews provider coding for professional & inpatient/outpatient services to ensure capture of diagnostic conditions supported within the provider's documentation for CMS/HHS Hierarchical Condition Categories (HCC). Supports risk adjustment data validation (RADV), medical record retrieval, vendor coding audits, provider engagement, & all risk adjustment ICD-10-CM coding-related activities. Conducts annual risk assessments, training,...

Sentara Health Plans in Virginia Beach, VA is seeking a Risk Adjustment Coder to perform compliance activities related to CMS/HHS risk adjustment and RADV audits. You will review professional and facility coding to ensure accurate HCC capture and support vendor and internal audits. The role requires an Associate degree or 4 years of coding experience, knowledge of ICD-10-CM guidelines, and CRC certification within two years. #J-18808-Ljbffr

## Compliance Coding AuditorApplyremote type: Remotelocations: Norfolk, VAtime type: Full timeposted on: Posted Yesterdayjob requisition id: JR-104491**City/State**Norfolk, VA**Work Shift**First (Days)**Overview:**# Compliance Coding AuditorPerforms 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...