Data & Coding Compliance Consultant

Sutter Health • Sacramento, CA

2d

About The Position

The position is responsible for advancing the mission of the Ethics and Compliance Services (ECS) in a manner consistent with the values and standards of the compliance profession. Functions as a subject matter expert and hospital facility coding compliance leader through the accurate development, review, and approval of system processes, directives, and tools regarding regulatory reporting and coding compliance with revenue cycle operations. Fosters strategic relationships within Sutter Health to maintain a culture of compliance, by providing accurate hospital facility coding compliance guidance and developing and delivering educational communications. A thorough understating of current hospital facility rules/ regulations/ guidelines/ policies/, coding and billing compliance, National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and ICD-10-CM/PCS, CPT, and HCPCS is necessary to ensure accurate guidance is provided to those functional teams who rely upon it. A CCS credential is required, with an RHIA, RHIT, CDIP or CCDS credential preferred. The position is responsible for participating in the department's annual risk assessment and work plan development processes and reviews. This includes project specific risk assessments, development of project objectives, scope, approach, deliverables, and assessment of the adequacy of operational action plans designed to mitigate identified risks. Is also responsible for assisting in investigations to provide subject matter expertise knowledge during an investigation. Participates in improving the efficient and effective delivery of Ethics and Compliance Services consultative, education, training, and complying with regulatory, system, department and professional standards, participating in department initiatives and internal process improvement projects throughout the revenue cycle environment, providing input into the enhancement of hospital facility coding, billing and reporting work flows and tools for the health system.

Requirements

• Bachelor Degree
• CCS-Certified Coding Specialist
• 5 years recent relevant experience.
• Ability to design and implement regulatory and specialty specific education/ training to a wide variety of professionals including but not limited to professional coders, physicians, clinical documentation improvement specialists, other coding education professionals, non-coding professionals.
• High level of expertise in the application of skills related to coding, billing, and reporting compliance.
• Thorough understanding of rules/ regulations/ guidelines/ policies/ protocols related to mandatory reporting requirements to OSHPD, coding and coding compliance, including National Coverage Determinations (NCDs), and Local Coverage Determinations (LCDs).
• Deep understanding of ICD-10-CM/PCS.
• Well-developed written, verbal, and interpersonal communication skills, including experience communicating to audiences of clinicians, physicians, health information leaders and practitioners.
• Experience performing coding/billing investigations, audits, or reviews.
• Computer skills, including business, coding, spreadsheet, presentation, word processing and analytical support applications.

Nice To Haves

• RHIA
• RHIT
• CDIP
• CCDS credential preferred

Responsibilities

• Accurate development, review, and approval of system processes, directives, and tools regarding regulatory reporting and coding compliance with revenue cycle operations.
• Fosters strategic relationships within Sutter Health to maintain a culture of compliance, by providing accurate hospital facility coding compliance guidance and developing and delivering educational communications.
• Participating in the department's annual risk assessment and work plan development processes and reviews.
• Assisting in investigations to provide subject matter expertise knowledge during an investigation.
• Participating in improving the efficient and effective delivery of Ethics and Compliance Services consultative, education, training, and complying with regulatory, system, department and professional standards
• Participating in department initiatives and internal process improvement projects throughout the revenue cycle environment
• Providing input into the enhancement of hospital facility coding, billing and reporting work flows and tools for the health system.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 11-50 employees