Aug 22, 2019
Under general direction from the Quality Assurance Manager, performs quality assurance monitoring reviews of clinical quality coding staff work activities to ensure compliance with the elements of the quality program such as Hierarchical Condition Category (HCC) / Medicare Advantage Program as well as coding guidelines and policies. Analyzes findings from quality monitoring reviews of coding staff, and other relevant coding data, in order to provide feedback and support for training and clinical documentation improvement efforts. Provides monitoring results to Clinical Quality Coding Lead as well as Clinical Quality Coding Manager and Clinical Quality Coding Educators with shared recommendations for course-correction and education as needed.
+ Bachelors preferred or equivalent education/experience
**Licensures and Certifications**
+ Certified Professional Coder (CPC), Certified Coding Specialist - Professional (CCS-P), and/or Certified Coding Specialist (CCS) required
+ Certified Risk Adjustment Coder (CRC) within 1 Year required
+ 6-9 years professional coding experience required.
+ Proficient use of grouper software and/or coding reference books to assign/validate diagnosis codes required.
+ 6 mos-2 years experience executing Coding Quality Assurance standards, processes, policies, procedures and service level agreements required.
+ Demonstrated experience in the fundamentals of auditing and monitoring required.
**Skills and Knowledge**
+ Advanced knowledge of ICD-10 diagnosis coding conventions and requirements, knowledge of Quality Coding Program requirements such as the Medicare Advantage Coding Program/HCC, as well as medical terminology and abbreviations of disease, illness and injury process.
+ Proficient use of software and/or coding reference books to assign/validate diagnosis codes.
+ Computer keyboarding skills and experience with computerized coding/abstracting systems and encoders Ability to use spreadsheet, word processing, statistical, project management, and presentation software applications, preferably Microsoft Suite.
+ Demonstrated strong written and verbal communications skills to influence others using one-on-one contact, formal presentations, and group discussions, with the ability to recognize the appropriate style, level of detail, and message for the audience.
+ Ability to ◦ build collaborate relationships with peers and other healthcare providers to achieve departmental and corporate objectives. ◦ ensure the privacy of each patient’s protected health information (PHI). ◦ work independently, as well as be part of the team, including accomplishing multiple tasks in an environment with interruptions.
**Organization:** Sutter Health System Office
**Employee Status:** Regular
**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.