Sutter Health Coding Compliance Auditor Novato Patient Services Full Time 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 the direction of the Regional Manager, Compliance, Risk and Privacy, this position is responsible for coding and compliance audits, billing research, and providing education/training to support various compliance activities of the Sutter Pacific Medical Foundation (SPMF).
Coding Audits and Billing Compliance Research:
• Performs coding audits of SPMF physicians and non-physician practitioners (NPP)
• Identifies and evaluates compliance risk areas.
• May perform focused or investigational audits or assist with compliance issues.
• Develops recommendations to improve business processes and reduce compliance risks.
• Prepares findings in a professional reporting format with accurate data in a spreadsheet, including graphs.
• Coordinate and conduct sample selection in the performance of regular and focus audits on a regular basis.
• Prepare report results with recommendations for corrective action plan (CAP), including follow up to ensure completion of CAP by providers and all necessary staff.
• Reviews and updates encounter forms on a regular basis to guarantee current and correct coding practices.
• Review and update Smart Text and Smart Phrases related to the EHR.
• Maintains current knowledge base in all aspects of CPT, HCPCS and ICD-9-CM coding.
• Keeps abreast of all current billing and coding rules and regulations affecting government and non-government payers, and disseminates information to appropriate individuals as needed.
• Reviews and researches billing issues, including but not limited to, rejection reports and claim denials.
• Assists and prepares Compliance Updates and Newsletters for SPMF providers and staff.
• Assists in timely preparation and follow through with governmental or other internal and external audits.
• Performs regular analysis of the impact of coding and clinical documentation on reimbursement and identifies trends and opportunities for improvements.
• Assists in other coding and compliance projects as necessary to ensure effective SPMF practices.
Bachelors degree or equivalent education/experience required.
Licensures and Certifications:
Certified Coding Specialist - CCS required.
• Experience in coding instruction with focus on E/M documentation.
• Minimum of four years related experience in professional fee billing and compliance, with extensive knowledge of Medicare and Medi-Cal guidelines, including teaching physician rules.
• Minimum of four years experience in education and training of physicians regarding coding and documentation guidelines.
• Five years of active E/M chart auditing experience within the last six years preferred.
Skills and Knowledge:
• Excellent organizational skills, thorough follow through and the ability to work independently with minimal supervision and maintain confidentiality in all activities.
• Thorough knowledge of medical terminology, standard medical abbreviations and disease processes.
• Excellent computer skills, including MS Excel, Word, and PowerPoint.
• Comprehensive knowledge of claims submission and medical billing software; IDX proficiency preferred.
• Excellent written and verbal communication skills.
• Strong customer service skills required; with the ability to work effectively with management, staff and physicians.
• Ability to trouble shoot, identify problem areas, develop and implement solutions.
• Ability to abstract from medical records, reports, chart entries, and related patient documentation required.
• Ability to manage multiple assignments and priorities.
Primary Location: California, North Bay/Lake County, Novato
Organization: Sutter Pacific Medical Foundation
Employee Status: Regular
Position Status: 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.