Coding Compliance Manager (DDQ)

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.

Qualified applicants with arrest and conviction records will be considered for employment. Applicants for specific positions are still required to disclose certain convictions during the application process, and those convictions may also be considered in determining eligibility for employment in accordance with applicable law.

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