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Award-winning: Sentara is a Virginia and Northeastern North Carolina based not-for-profit integrated healthcare provider that has been in business for over 131 years. Offering more than 500 sites of care including 12 hospitals, PACE (Elder Care), home health, hospice, medical groups, imaging services, therapy, outpatient surgery centers, and an 858,000 member health plan. The people of the communities that we serve have nominated Sentara “Employer of Choice” for over ten years. U.S. News and World Report has recognized Sentara as having the Best Hospitals for 15+ years. Sentara offers professional development and a continued employment philosophy!
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
Key Responsibilities
This includes but is not limited to establishing 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.
This position is responsible for the oversight of all pre and post payment audit functions, medical documentation requests and is responsible for maintaining a tracking system for all audits/requests activity throughout all levels of appeals.
Education:
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Bachelor’s degree (Required).
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Candidates with a total of 4 years of healthcare appeals experience will be considered in lieu of the Bachelor's Degree requirement
Experience:
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3 years of healthcare appeals experience (Required)
Sentara prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
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