Coding Compliance Manager (DDQ) - Sutter Health
Sacramento, CA
About the Job
Organization:
SHSO-Sutter Health System Office-Valley
Position Overview:
Leads program development, compliance integration, documentation, and data quality, implementation, and guidance for the Sutter Health system. Provides a firm foundation of research and impact analysis to support effective organizational and operational decision making related to a wide variety of revenue regulatory issues that impact abstraction of data for coding purposes. Gives leadership and direction to the system's regional/entity physicians, nurses, clinicians, department managers, coding experts and through programs of education, policy development, support and evaluation, assures that coding practices are appropriate. Assists with the assessment of potential or existing risk in regulatory and/or coding practices and conducts or coordinates research as needed to answer questions and resolve documentation and data quality issues identified through the compliance program.
Job Description :
The person hired for this role must live in the Northern California Sutter Health Footprint and come on site for meetings, trainings, etc.
EDUCATION:
_Equivalent experience will be accepted in lieu of the required degree or diploma._
Bachelor's: Business Administration, Healthcare (RHIT) or related field
CERTIFICATION & LICENSURE:
CCS-Certified Coding Specialist
OR CPC-Certified Professional Coder
OR CRC-Certified Risk Adjustment Coder
OR CCDS-Certified Clinical Documentation Specialist
OR CIC-Certified Inpatient Coder
TYPICAL EXPERIENCE:
10 years recent relevant experience
SKILLS AND KNOWLEDGE:
• The position requires excellent critical thinking skills and knowledge of MS DRGs, APR DRGs, APCs, Official Coding Guidelines, and a broad-based and thorough understanding of ICD-10 CM, PCS coding and CPT/HCPCS systems. Ability to adapt to changes in the workload and work functions, to work independently and to effectively prioritize work assignments.
• Demonstrated understanding of data interpretation and applicability, risk assessment and control
environments, and of the professional practice standards of coding.
• Current knowledge of coding methodologies such as ICD.9, ICD.10, HCPCs, CPT, discharge data sets
reporting for OSHPD, POA reporting, MS-DRG, NCD/LCD.
• Working knowledge of management of an effective ethics and compliance program, including auditing,
training, monitoring, conducting and documenting investigations, addressing violations and monitoring
corrective actions.
• Familiarity with healthcare compliance requirements is essential, including a working knowledge of federal
and state reimbursement program requirements (e.g., Medicare and Medi-Cal) and federal and state fraud
and abuse, anti-kickback, and physician self-referral laws.
• Well versed in current healthcare compliance issues, OIG enforcement activities, and other applicable
regulations such as HIPAA, licensure requirements, and quality standards.
• Understanding of healthcare operations, revenue cycle, billing, coding, and healthcare it environments.
• Written and verbal communication skills, including ability to present regulatory requirements, directives,
ideas and concepts effectively to a diverse audience.
Job Shift :
Days
Schedule :
Full Time
Shift Hours:
8
Days of the Week:
Friday, Monday, Thursday, Tuesday, Wednesday
Weekend Requirements:
None
Benefits:
Yes
Unions:
No
This position is work from home eligible.
Position Status:
Exempt
Weekly Hours:
40
Employee Status:
Regular
Number of Openings:
1
Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.
Pay Range is $62.95 to $94.42 / hour
_The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package._
All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.
SHSO-Sutter Health System Office-Valley
Position Overview:
Leads program development, compliance integration, documentation, and data quality, implementation, and guidance for the Sutter Health system. Provides a firm foundation of research and impact analysis to support effective organizational and operational decision making related to a wide variety of revenue regulatory issues that impact abstraction of data for coding purposes. Gives leadership and direction to the system's regional/entity physicians, nurses, clinicians, department managers, coding experts and through programs of education, policy development, support and evaluation, assures that coding practices are appropriate. Assists with the assessment of potential or existing risk in regulatory and/or coding practices and conducts or coordinates research as needed to answer questions and resolve documentation and data quality issues identified through the compliance program.
Job Description :
The person hired for this role must live in the Northern California Sutter Health Footprint and come on site for meetings, trainings, etc.
EDUCATION:
_Equivalent experience will be accepted in lieu of the required degree or diploma._
Bachelor's: Business Administration, Healthcare (RHIT) or related field
CERTIFICATION & LICENSURE:
CCS-Certified Coding Specialist
OR CPC-Certified Professional Coder
OR CRC-Certified Risk Adjustment Coder
OR CCDS-Certified Clinical Documentation Specialist
OR CIC-Certified Inpatient Coder
TYPICAL EXPERIENCE:
10 years recent relevant experience
SKILLS AND KNOWLEDGE:
• The position requires excellent critical thinking skills and knowledge of MS DRGs, APR DRGs, APCs, Official Coding Guidelines, and a broad-based and thorough understanding of ICD-10 CM, PCS coding and CPT/HCPCS systems. Ability to adapt to changes in the workload and work functions, to work independently and to effectively prioritize work assignments.
• Demonstrated understanding of data interpretation and applicability, risk assessment and control
environments, and of the professional practice standards of coding.
• Current knowledge of coding methodologies such as ICD.9, ICD.10, HCPCs, CPT, discharge data sets
reporting for OSHPD, POA reporting, MS-DRG, NCD/LCD.
• Working knowledge of management of an effective ethics and compliance program, including auditing,
training, monitoring, conducting and documenting investigations, addressing violations and monitoring
corrective actions.
• Familiarity with healthcare compliance requirements is essential, including a working knowledge of federal
and state reimbursement program requirements (e.g., Medicare and Medi-Cal) and federal and state fraud
and abuse, anti-kickback, and physician self-referral laws.
• Well versed in current healthcare compliance issues, OIG enforcement activities, and other applicable
regulations such as HIPAA, licensure requirements, and quality standards.
• Understanding of healthcare operations, revenue cycle, billing, coding, and healthcare it environments.
• Written and verbal communication skills, including ability to present regulatory requirements, directives,
ideas and concepts effectively to a diverse audience.
Job Shift :
Days
Schedule :
Full Time
Shift Hours:
8
Days of the Week:
Friday, Monday, Thursday, Tuesday, Wednesday
Weekend Requirements:
None
Benefits:
Yes
Unions:
No
This position is work from home eligible.
Position Status:
Exempt
Weekly Hours:
40
Employee Status:
Regular
Number of Openings:
1
Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.
Pay Range is $62.95 to $94.42 / hour
_The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package._
All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.
Source : Sutter Health