Supervisor, Coding Audit
Company: Palo Alto Medical Foundation
Posted on: January 16, 2020
Job Summary: Under general direction from the Coding Manager, this
position oversees the Coding Audit & Compliance Program for the Bay
Area Operating Unit. This includes supervising a team of coding
auditors that perform annual provider audits, focused (ad-hoc)
coding audits, and monitor coder accuracy through coder quality
assurance reviews (Q/A's). In partnership with the Coding Quality
and Education Manager, this position will assist in developing the
education plan (resulting from annual provider audits, ad-hoc
medical group/provider requests, etc.). This position plays a
strategic role in validating the accuracy of HCPCS and diagnosis
code assignment by coders and physicians to ensure compliance with
governmental regulations, coding guidelines, and State and Federal
reporting requirements. Compliance includes management of the audit
tool (MD Audit) and ensuring its efficacy in risk reduction and
will partner with the Director of Coding in the creation of a
coding audit workplan that stems from several regulatory resources
such as the OIG workplan, RAC reports, etc. The coding audit
supervisor will also be the single point of accountability for
Sutter Health system level audits and will facilitate the
corrective action plans (CAPs) and ensure that timely submission is
completed and adhered to within system and regulatory
refund/payback requirements. This position is actively involved in
the dissemination of coding requirements and updates to appropriate
- Supervises Coding Quality for Assigned Foundations: Ensures
that focused coding audits and coding programs are effective and
efficient to evaluate compliance with policy, coding (ICD-10,
HCPCS) & billing (NCCI, etc.), and regulatory (CMS) requirements.
Under the direction of Coding Director, assists in developing
strategy and programs to address non-compliant or high-risk coding
practices. Assess professional and facility coding and patient care
documentation practices to ensure compliance with pertinent
regulations and guidelines (e.g. copy and paste, Scribe guidelines,
etc.). Ensures Coding Audit and Compliance Programs are aligned to
support Affiliate Compliance Initiatives and assists the Coding
Managers in implementing corrective action plans, creation of
policies & procedures, and internal controls (e.g. coder Q/A's,
etc.) which reinforces the highest level of standard of coding
- Supports Coding Education Programs for Assigned Foundations:
Ensures the effectiveness of education and training programs.
Participates in assisting with the new provider on-boarding through
identification; auditing and facilitation of audit packets and
management. Based on identified trends and patterns in coding and
documentation variances, provides a feedback to coding educators.
Partners with the Coding Managers to create an education plan that
is consistent across all accountable affiliates. Assures all
educational materials are accurate and methods of education are
appropriate. In partnership with the Coding Education Manager,
assists in developing coder training programs (e.g. new
coder/specialty, continued training, etc.) Partners with Coding
Manager's on coding initiatives (e.g. edits reduction, etc.)
- Serves as a Coding Compliance Support: Partners with the Coding
Education Manager in researching, summarizing, and disseminating
information regarding new coding requirements (e.g. annual CPT code
updates, etc.) and updates appropriate management, providers and
coding staff of changes. Serve as a resource for department
managers, physicians, and administration to obtain information and
clarification on accurate and ethical coding standards, guidelines
and regulatory requirements. Acts as a coding support and ensuring
the education program addresses the findings of quality
audits/focused coding reviews. This includes being the point of
contact for the audit tools used (e.g. MD Audit). Develops training
materials and coding aids for both formal training and use by
coders in daily work (one point lessons, etc.). Acts as a single
point of accountability for Sutter Compliance (ECS) when it comes
to managing and monitoring corrective action plans (CAPs). This
includes the facilitation of different areas related to CAP items
and the construction of the initial CAP for leadership
- Staff Management and Financial Management for Assigned
Foundations: Responsible for day to day management of the audit
team members which includes implementing and maintaining staff
productivity and quality standards. Identifies opportunities for
enhancing cost effective delivery of services and direct
accountability for developing standard work and decreasing waste.
Utilizes Lean Management to develop standard work and continuous
process improvement within the department.
- Other: Works on other projects, as assigned. Performs
additional functions and projects as assigned by Management
Required: High School Diploma or Equivalent; CCS-P, CPC, COC, or
- At least three (3) years recent coding experience
- With at least one (1) year coding auditing experience in a
health care setting.
- One (1) year of management.
- Knowledge of Epic Resolute and Ambulatory, PowerPoint, Excel,
including charts and pivot tables.
- ICD-10, CPT, and HCPCS coding knowledge inclusive of associated
billing edits such as NCCI.
- Ability to review, analyze, and interpret billing guidelines
and state and federal regulations.
- Experience in LEAN management preferred. Experience with coding
auditing tools such as MD Audit
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, nationalorigin
(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 backgroundcheck/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.
Keywords: Palo Alto Medical Foundation, Sunnyvale , Supervisor, Coding Audit, Accounting, Auditing , Sunnyvale, California
Didn't find what you're looking for? Search again!