Sutter Health Clinical Quality Coder Regional Quality Management in Novato, California
Sutter Pacific Medical Foundation is a not for profit corporation that exists to provide medical services, research and education. The foundation provides the infrastructure for the delivery of physician services, and contracts with a separate corporation comprised of physicians and other care providers to deliver the clinical services. This multi-specialty foundation will provide a platform from which new physicians can be recruited to continue to provide physician services in a nonprofit, community setting. The Foundation's vision is to create a medical group that will deliver high quality, market competitive medical services.
Under general direction from the Clinical Quality Supervisor, the Clinical QualityCoder will be responsible for reviewing member records to validate assigned diagnosis codes by physicians and other qualified health care providers and assign diagnosis codes from clinical documentationin keeping with Sutter Health's coding policies and procedures and accepted Official Coding Guidelines for accurate diagnosis code reporting. This Clinical Quality Coder is responsible for monitoring diagnosiscode accuracy (validates the assigned ICD-10-CM codes or assigns based on clinical documentation), understandingthe encounter data transmission processes for assigned medical groups, and partners with the Clinical Quality Coding Education team to provide education and training to clinical providers on medical record documentation requirements to support accurate diagnosis code assignment. This position also assists in coaching/training Physician champions, management and staff on the guidelines and standards set forth by the American Hospital Association Official Guidelines for Coding and the Centers for Medicare and Medicaid Services for Medicare Risk Adjustment reporting requirements. . This position also assists Clinical Quality Coding Supervisor in partnering with Ethics and Compliance Services to develop and implement systempolicies and procedures.
· HS Diploma – Required
Licensure and Certifications
· Certified coding Specialist – CCS – Required
· Certified Professional Coder – CN-P CODER – Required
· CPC-A, CPC, CCS, CCS-P, COC OR CPC-P, CRC –Required
· 1-2 years coding or billing experience (or equivalent education) in a physician office, hospital, or other ambulatory care setting required.
Skills and Knowledge
· AHIMA or AAPC Coding Certification required (CPC-A with at least 1 year coding experience or CPC, CCS, CCS-P, COC, or CPC-P, CRC) required.
· Knowledge of Epic Resolute and Ambulatory, PowerPoint, Excel, including charts and pivot tables.
· ICD-10, CPT, and HCPCS coding knowledge inclusive of associated billing edits such as NCCI.
· Ability to review, analyze, and interpret billing guidelines and state and federal regulations.
· Experience with LEAN management preferred.
· Experience with Ingenix Encoder Pro, 3M or other encoding software tools.
· Experience in Microsoft Suite of products such as PowerPoint, Visio, Excel including using pivot tables, formulas and graphics preferred.
· PM or weekend shift – rarely
· Possible travel to PAMF, SPMF, SEBMF locations. May be asked to travel to Sacramento (rarely).
Organization: Sutter Pacific Medical Foundation
Employee Status: Regular
Position Status: Non-Exempt
Job Shift: Day
Shift Hours: 8 Hour Shift
Days of the Week Scheduled: Monday-Friday
Weekend Requirements: None
Schedule: Full Time
Hrs Per 2wk Pay Period: 80
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.