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Sutter Health Director, Coding in Sunnyvale, California

Position Overview:

As the Director, Coding, you will be accountable for all operational and fiscal duties for professional coding within the Bay Operating Unit. You will have system oversight for all activities associated with accurate coding, such as coding compliance audits and provider education. You will collaborate closely with business operations that support revenue cycle activity, physicians, clinical operations and internal teams within Ethics and Compliance. Additionally, you will be accountable to:

  • Develop, implement and oversee a Hierarchical Condition Category (HCC)/Risk Adjustment Factor (RAF) program

  • Implement and monitor HCC/RAF strategies across all applicable divisions

  • Ensures maximum reimbursement by involvement in critical work in system workflow development, documentation and analysis

  • Supports financial initiatives by ensuring accurate and timely coding submission of provider encounters, identification of coding opportunities and reduce coding denials

  • Lead people and teams in business matters that positively reflect the values and ethics of Sutter Health

  • Drive key performance indicators to ensure a high-performing shared services organization

  • Provide guidance and prioritization of system initiatives related to coding, documentation and reimbursement data quality

  • Monitor and ensure all Epic Coding WQs are current

  • Ensure billing errors resulting from coding discrepancies are efficiently investigated and validated, providing proper feedback to physicians, staff and/or department heads

  • Evaluate and assess coding denials to ensure timely correction and/or prevention and develop strategic processes to correct and prevent denials through research and trending of data

  • Ensure all departments have a dedicated coding resource to provide real time feedback on a regular basis

  • Provide analysis, dashboards and reports required by physicians and leadership to promote accurate coding and reimbursement

Our ideal candidate will possess superior interpersonal qualities with an ability to articulate a vision and influence others in the support of broad objectives and accomplishment of strategic aims. The ability to lead people and teams to ensure timely execution of projects and assignments is essential. You should have a proven track record sound decision making.

Qualifications:

  • Bachelor’s Degree in Business or related field or equivalent education/experience

  • 5 or more years of healthcare operations leadership experience

  • Demonstrated leadership experience with a proven track record in coding, revenue cycle and Health Information Management

  • Extensive knowledge of CPT, HCPCS and ICD-10 coding

  • Comprehensive knowledge of revenue cycle functions in an ambulatory setting, including charge capture, coding and billing

  • Experience managing complex, large-scale transformational and integration projects, including cost containment initiatives, planning new or expanded services and coordinating multi-departmental task forces

  • Demonstrated leadership experience in planning new or expanded services, managing projects and coordinating multi-department task forces

  • Demonstrated experience in budget preparation and planning, developing and monitoring of staff productivity systems analysis and tracking, quality improvement and establishment of quality standards and monitors, and the implementation of other key management control systems

Organization: Palo Alto Medical Foundation

Employee Status: Regular

Employee Referral Bonus: No

Benefits: Yes

Position Status: Exempt

Union: No

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.

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