Sentara Health
Overview
The Revenue Integrity Auditor will perform detailed audits of the medical record at Sentara facilities, by researching and analyzing the accuracy of the medical record documentation to the itemized bill to ensure charges are defensible under scrutiny with our payers. The Revenue Integrity Auditor ensures adherence to regulatory requirements related to billing and supporting documentation, as well as facilitates the completion of appeals in a timely manner. This position identifies and works collaboratively to correct discrepancies in patient charges and can participate in engagements involving payer contracts, regulatory compliance, revenue integrity, and operational assessments. This position is responsible for the coordination of external reviews / audits, including but not limited to Medicare, Medicaid, or Commercial payers; pre and/or post documentation, commercial insurance medical records request/reviews. City/State:
Norfolk, VA Work Shift:
First (Days) Key Responsibilities
Establish workflows, policies and procedures, software analysis and maintenance and implementation of processes and communication plans for the facility\'s interactions with third party auditors including but not limited to pre and post payment Medicare, Medicaid and commercial insurances reviews to ensure timely completion or review/audit documentation requests. Oversight of all pre and post payment audit functions, medical documentation requests and maintenance of a tracking system for all audits/requests activity throughout all levels of appeals. Education
Bachelor’s degree (Required). Candidates with a total of 4 years of healthcare appeals experience will be considered in lieu of the Bachelor\'s Degree requirement. Certification
CHRI – Certified in Healthcare Revenue Integrity Certified Professional Coder (CPC) Certified Outpatient Coder (COC) Certified Professional Medical Auditor Certified Coding Associate Certified Coding Specialist Registered Health Information Technician Registered Health Information Administrator Experience
3 years of healthcare appeals experience (Required) Benefits
Medical, Dental, Vision plans Adoption, Fertility and Surrogacy Reimbursement up to $10,000 Paid Time Off and Sick Leave Paid Parental & Family Caregiver Leave Emergency Backup Care Long-Term, Short-Term Disability, and Critical Illness plans Life Insurance 401k/403B with Employer Match Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education Student Debt Pay Down – $10,000 Reimbursement for certifications and free access to complete CEUs and professional development Pet Insurance Legal Resources Plan Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met. Equal Opportunity
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its workforce. This includes a tobacco-free environment and a commitment to diversity, inclusion, and belonging. Remote work eligibility
For positions available as remote work, Sentara Health employs associates 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.
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The Revenue Integrity Auditor will perform detailed audits of the medical record at Sentara facilities, by researching and analyzing the accuracy of the medical record documentation to the itemized bill to ensure charges are defensible under scrutiny with our payers. The Revenue Integrity Auditor ensures adherence to regulatory requirements related to billing and supporting documentation, as well as facilitates the completion of appeals in a timely manner. This position identifies and works collaboratively to correct discrepancies in patient charges and can participate in engagements involving payer contracts, regulatory compliance, revenue integrity, and operational assessments. This position is responsible for the coordination of external reviews / audits, including but not limited to Medicare, Medicaid, or Commercial payers; pre and/or post documentation, commercial insurance medical records request/reviews. City/State:
Norfolk, VA Work Shift:
First (Days) Key Responsibilities
Establish workflows, policies and procedures, software analysis and maintenance and implementation of processes and communication plans for the facility\'s interactions with third party auditors including but not limited to pre and post payment Medicare, Medicaid and commercial insurances reviews to ensure timely completion or review/audit documentation requests. Oversight of all pre and post payment audit functions, medical documentation requests and maintenance of a tracking system for all audits/requests activity throughout all levels of appeals. Education
Bachelor’s degree (Required). Candidates with a total of 4 years of healthcare appeals experience will be considered in lieu of the Bachelor\'s Degree requirement. Certification
CHRI – Certified in Healthcare Revenue Integrity Certified Professional Coder (CPC) Certified Outpatient Coder (COC) Certified Professional Medical Auditor Certified Coding Associate Certified Coding Specialist Registered Health Information Technician Registered Health Information Administrator Experience
3 years of healthcare appeals experience (Required) Benefits
Medical, Dental, Vision plans Adoption, Fertility and Surrogacy Reimbursement up to $10,000 Paid Time Off and Sick Leave Paid Parental & Family Caregiver Leave Emergency Backup Care Long-Term, Short-Term Disability, and Critical Illness plans Life Insurance 401k/403B with Employer Match Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education Student Debt Pay Down – $10,000 Reimbursement for certifications and free access to complete CEUs and professional development Pet Insurance Legal Resources Plan Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met. Equal Opportunity
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its workforce. This includes a tobacco-free environment and a commitment to diversity, inclusion, and belonging. Remote work eligibility
For positions available as remote work, Sentara Health employs associates 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.
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