The **RAF Coding & Education Analyst** is responsible for; auditing, analyzing, and reporting clinical and billing documentation to support and improve HCC (hierarchical condition categories) coding within Sutter Medical Foundation. Additionally this position also provides education and operational support to clinicians and care center management to support and improve the overall RAF (Risk Adjustment Factor) score for Sutter Medical Foundation.
I. Conducts internal audits throughout the _Sutter Medical Foundation_ organization.
· Performs HCC audits for Sutter Medical Foundation and affiliated medical groups.
· Identifies and evaluates improved RAF score opportunities.
· Maintains familiarity with organizational and departmental goals and objectives to determine whether objectives are currently being achieved.
· Develops recommendations to improve business processes to support and/or improve RAF scores.
· Develops and maintains tools for tracking and reporting HCC and RAF score data.
· Utilizes third party software to identify HCC coding improvement opportunities.
II. Writes initial and final draft of HCC audit reports and/or memoranda.
· Develops findings, outlines the criteria, controls and conditions found.
· Determines the nature of corrections and resources needed.
· Develops overall recommendation to correct or improve the deficiency.
· Meets with management to orally communicate the results of the audit or give a presentation relating to the project that was completed.
· Meets with medical group leadership as well as individual physicians, to review audit findings, and develop an improvement plan to meet organizational goals.
III. Performs follow-up reviews to determine whether improvement plan has been properly implemented.
· Reviews the recommendations for improvement plan, follow-up action taken and current operations.
· Notes discrepancies and/or continuing areas needing attention.
· Writes report for follow-up review.
IV. Maintains effective working relationships and adheres to applicable policies and procedures.
· Acts as a resource to medical group clinicians and Sutter Medical Foundation staff for HCC coding, and RAF score program. Keeps current on all RAF program policies and procedures.
· Creates an environment that facilitates open communications and a constructive approach in addressing audit findings and completing special projects.
· Provides advice to managers regarding effective internal controls, system development and administrative controls.
· Adheres to departmental and Sutter Medical Foundation policies, procedures and guidelines.
· Assists in developing auditing policies and procedures as well as departmental objectives.
V. Universal Criteria
A. Commitment to Quality
· Demonstrates commitment to quality through knowledge of its precepts, skillful workplace applications and continuous organizational improvement.
· Demonstrates responsibility for ongoing personal development, professional growth and continuing education.
B. Planning and Time Utilization
· Performs duties in a self directed manner with minimal supervision or direction.
· Ensures that routine and priority tasks are completed within established departmental time frames.
C. Policies and Procedures
· Demonstrates a clear understanding of, and consistently adheres to department and facility policies and procedures.
· Attends and actively participates in department and facility meetings and classes.
· Follows safety procedures, operates equipment and performs job related duties in a safe manner which prevents accidents from occurring.
· Observes the departmental dress and grooming code standards and consistently wears identification badge.
D. Attendance and Reliability
· Sick or absent time off does not exceed the facility guidelines as outlined in the Human Resource Policy manual.
Provides proper notification of absence or tardiness within established departmental time frames.
**MINIMUM POSITION REQUIREMENTS:**
Requires a Bachelor’s degree in Business/Healthcare Administration, Finance, Nursing, or equivalent experience.
CCS, CCS-P, CPC or CPC-H certification is required.
Requires at least 1 year of experience in a physician practice setting. Experience should include billing and/or coding for Medicare, Medi-Cal (Medicaid), managed care and other third party fee for service payers. Experience in Patient Financial Services helpful.
RAF Coding & Education Analyst experience should include auditing physician clinical documentation for both ICD-9 and CPT/HCPCS coding accuracy.
CPT-4, HCPCS and ICD-9-CM coding
Government billing regulations, including; Medicare, Medicare Managed Care and Medi-Cal/Medicaid. Medical Terminology.
+ **Special Skills/Equipment:**
Must have excellent written and verbal communication skills
Microsoft Office including Word and Excel
Ability to manage multiple assignments and priorities
Knowledge of IDX and Epic software applications
Data analysis skills.
**Primary Location:** California, Greater Sacramento Area, Sacramento
**Organization:** Sutter Medical Foundation - Central
**Employee Status:** Regular
**Employee Referral Bonus:** No
**Position Status:** Exempt
**Job Shift:** Day
**Shift Hours:** 8 Hour Shift
**Days of the Week Scheduled:** Monday-Friday
**Weekend Requirements:** Other
**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.
Sutter Health values and supports the unique talents and strengths that each employee brings to our organization. As a result, you are empowered to apply your passion for healing in innovative ways to care for patients and their families.
Collaborating with the best and the brightest means a dynamic, fulfilling work experience for you – and excellent, personalized care for all those we serve.