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Supervisor, Coding Audit

Company: Palo Alto Medical Foundation
Location: Sunnyvale
Posted on: January 16, 2020

Job Description:

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 stakeholders.

  • 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 quality.
  • 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 approvals.
  • 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 CPC-P.

    • 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

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