Clinical Revenue Compliance Auditor

2 weeks ago


Chesapeake, Virginia, United States Children's Hospital Of The King's Daughters Full time
  • GENERAL OVERVIEW
    • The Clinical Revenue Compliance Auditor plays a crucial role in ensuring the auditing and compliance processes that facilitate accurate and comprehensive reimbursement from third-party payers to the healthcare system. This position reports directly to departmental leadership.
  • KEY RESPONSIBILITIES
    • Guarantees compliance with regulatory standards concerning billing and supporting documentation, while also expediting the completion of appeals as necessary.
    • Generates trend analyses and various reports for compliance audits and charge processes.
    • Acts as a resource for hospital departments regarding adherence to billing regulations and trends in service denials due to medical necessity or appropriateness.
    • Conducts compliance audits, defense audits, LifeNet audits, and special focus audits, documenting findings thoroughly.
    • Provides clinical expertise for coding, denial management, and customer service inquiries.
    • Contributes as a member of the chargemaster team, offering clinical insights and expertise on compliance-related charge functions.
    • Identifies and collaborates to rectify discrepancies in patient billing.
    • Performs additional duties as assigned.
  • CERTIFICATIONS AND LICENSES
    • Must possess a current Virginia state license as a Registered Nurse or a valid Compact State license.
    • Certification as a Professional Coder is required.
    • Certification as a Certified Outpatient Coder (COC; previously CPC-H) must be obtained within one year of employment.
  • EDUCATIONAL AND EXPERIENCE REQUIREMENTS
    • A Bachelor of Science in Nursing is required.
    • A minimum of three years of clinical experience as a Certified Professional Coder is essential.
    • Preferred experience includes three to five years in case management utilization review or compliance-related roles within a hospital environment.
    • Pediatric experience is advantageous.
    • Current knowledge of third-party billing, appeals processes, and regulatory requirements is necessary.
    • Exceptional analytical skills are required to assess the appropriateness of patient charges in relation to medical records and third-party reimbursement.
    • Strong interpersonal skills are necessary for effective communication with other professionals.
    • Proficiency in MS Office and health record management systems is required.
    • Knowledge of quality management methodologies, medical record documentation, compliance standards, and performance improvement systems is essential.
    • Ability to prepare detailed reports and summaries is required.
  • WORK ENVIRONMENT
    • This position is typically situated in a standard office environment with minimal exposure to excessive noise, dust, or extreme temperatures.
  • PHYSICAL DEMANDS
    • Refer to the detailed physical requirements for this position.

  • Senior Auditor

    2 weeks ago


    Chesapeake, Virginia, United States Careerbuilder-US Full time

    Position Overview - The Senior Internal Auditor plays a crucial role in conducting comprehensive internal audit functions. This includes financial audits, compliance evaluations, risk-based operational assessments, data analysis, ongoing monitoring, advisory projects, process enhancements, and special initiatives. The auditor is responsible for defining...

  • Senior Auditor

    1 week ago


    Chesapeake, Virginia, United States Careerbuilder-US Full time

    Position Overview - The Senior Internal Auditor plays a crucial role in executing internal audit functions, which encompass financial audits, compliance assessments, risk-based operational evaluations, data analysis, ongoing monitoring, advisory projects, process enhancements, and unique assignments. The auditor is responsible for outlining the audit scope...


  • Chesapeake, Virginia, United States Courtyard Chesapeake Greenbrier VA Full time

    Position OverviewHotel Equities is in search of a dedicated Overnight Hotel Auditor for our esteemed establishment, Courtyard Chesapeake Greenbrier. The successful candidate will play a vital role in delivering outstanding service to our guests during the night shift.Key Responsibilities:Facilitate the check-in and check-out process for guests, ensuring all...

  • Senior Auditor

    1 week ago


    Chesapeake, Virginia, United States Careerbuilder-US Full time

    Position Overview - The primary purpose and key functions of this role involve conducting internal audit operations. The Senior Auditor operates independently or collaborates with project teams to execute a variety of internal audit tasks, including financial assessments, compliance evaluations, risk-based operational audits, data analysis, ongoing...

  • Data Analyst/Auditor

    3 months ago


    Chesapeake, Virginia, United States Bayview Physicians Group Full time

    Full job descriptionHealthcare Data AnalystBayview Physicians Group – Chesapeake, VABayview Physicians Group, the largest private multi-specialty group in Virginia has an exciting, full time opportunity for a Healthcare Data Analyst within our administrative office supporting 300 medical providers and 75 office locations. Under the supervision of the...


  • Chesapeake, Virginia, United States Jobot Full time

    Senior Internal Auditor RoleCompany Overview:Jobot is a leading producer in the building materials sector across North America, with operations spanning several states. We are in search of a proficient Senior Internal Auditor with a minimum of 5 years of relevant experience to enhance our team.What We Offer:Attractive Compensation PackageFlexible Work...

  • Clinical Supervisor

    5 days ago


    Chesapeake, Virginia, United States Lighthouse Therapeutic Services Full time

    Job SummaryThis position is responsible for providing clinical supervision to QMHPs (trainees and paraprofessionals) at Lighthouse Therapeutic Services, LLC. The incumbent will perform initial assessments, make diagnoses, and provide guidance on safe and therapeutic practices.Key ResponsibilitiesPerform initial assessments and make diagnosesProvide clinical...


  • Chesapeake, Virginia, United States Jobot Full time

    Senior Internal Auditor RoleCompany Overview:Jobot is a leading manufacturer in the building materials sector across North America, with operations spanning various states. We are in search of a proficient Senior Internal Auditor with a minimum of 5 years of relevant experience to enhance our team.Benefits of Joining Us:Attractive Compensation...

  • Clinical Pharmacist

    18 hours ago


    Chesapeake, Virginia, United States Potomac Healthcare Solutions Full time

    Job SummaryPotomac Healthcare Solutions is seeking a highly skilled Clinical Pharmacist to join our team in providing exceptional patient care and services in an ambulatory care setting.Key ResponsibilitiesDeliver comprehensive pharmaceutical services, ensuring accuracy and quality in all prepared or processed products.Collaborate with clinical staff to...


  • Chesapeake, Virginia, United States Lighthouse Therapeutic Services Full time

    Job OverviewPosition Title: Clinical Supervisor (LMHP)Reports To: Clinical DirectorCLASS SUMMARY:This role is responsible for conducting initial evaluations, diagnosing conditions, and offering clinical oversight to the Qualified Mental Health Professionals (QMHPs) at LIGHTHOUSE THERAPEUTIC SERVICES, LLC. The Clinical Supervisor ensures the delivery of...


  • Chesapeake, Virginia, United States Chesapeake Regional Medical Center Full time

    Position OverviewThe Senior Clinical Laboratory Technologist plays a crucial role in the healthcare team at Chesapeake Regional Medical Center. This position involves conducting a variety of laboratory tests on patient samples, utilizing both manual and automated techniques to ensure accurate results for the diagnosis and management of diseases.Key...

  • Front Desk Manager

    5 days ago


    Chesapeake, Virginia, United States LTD Hospitality Group Full time

    Job SummaryLTD Hospitality Group is seeking a highly motivated and experienced professional to join our team as a Night Auditor. As a key member of our hotel operations team, you will be responsible for ensuring the smooth and efficient operation of our front desk during the night shift.Key ResponsibilitiesGuest Services: Provide exceptional guest service,...


  • Chesapeake, Virginia, United States Commonwealth of Virginia Full time

    Position OverviewAs a Clinical Nurse Specialist, you will deliver comprehensive nursing care within correctional facilities by employing the nursing process, which includes assessment, planning, implementation, and evaluation of patients in accordance with established standards of practice. Your role is vital in ensuring quality care through various...


  • Chesapeake, Virginia, United States Personal-Touch Home Care Full time

    Position Overview:We are seeking a dedicated and experienced Clinical Manager/RN to oversee our home health care operations. The ideal candidate will possess a minimum of 2 years of experience in home health care as a Registered Nurse (RN) and at least 1 year of supervisory experience, preferably in a home health setting.About Us:With over 45 years of...

  • Clinical Supervisor

    3 days ago


    Chesapeake, Virginia, United States Sentara Healthcare Full time

    Job SummarySentara Healthcare is seeking a highly skilled Clinical Supervisor to join our Home Care team in Chesapeake. As a Clinical Supervisor, you will play a critical role in coordinating patient care resources to meet the clinical needs of patients.Key ResponsibilitiesOversee a multidisciplinary team to facilitate appropriate and efficient clinical...


  • Chesapeake, Virginia, United States Jobot Full time

    About the RoleWe are seeking a highly experienced Financial Controls Accountant to join our team at Jobot. As a key member of our finance department, you will play a critical role in ensuring the accuracy and integrity of our financial reporting and compliance processes.Key ResponsibilitiesDesign, implement, and document accounting and financial reporting...


  • Chesapeake, Virginia, United States City of Chesapeake Full time

    Job DescriptionWe are seeking a highly skilled and experienced professional to join our team as a Clinical Program Supervisor. As a key member of our organization, you will play a critical role in the success of our Infant and Toddler Connection program.Key Responsibilities:Program Management: Serve as the Local System Manager for the Infant & Toddler...


  • Chesapeake, Virginia, United States Careerbuilder-US Full time

    Position OverviewThe Lease Accounting Analyst plays a crucial role in managing the financial aspects of occupancy costs across the organization. This position is essential for ensuring accurate budgeting, forecasting, and reporting.Key ResponsibilitiesMonthly Financial Analysis: Conduct thorough monthly analyses and reporting of occupancy expenses,...


  • Chesapeake, Virginia, United States Careerbuilder-US Full time

    Position OverviewThe Lease Accounting Analyst plays a critical role in managing and analyzing occupancy expenses across the organization. This position is integral to the financial health of the enterprise, ensuring accurate budgeting, forecasting, and reporting of lease-related costs.Key ResponsibilitiesMonthly Analysis and Reporting:Conduct thorough...

  • Pharmacy Manager

    3 days ago


    Chesapeake, Virginia, United States Walgreens Full time

    Job SummaryAs a Pharmacy Manager at Walgreens, you will play a critical role in providing exceptional patient care and services. This position requires a strong background in pharmacy operations, management, and clinical services.Key ResponsibilitiesPatient Experience: Engage patients by greeting them and offering assistance with products and services....