Note: The job is a remote job and is open to candidates in USA. Stanford Health Care is a healthcare organization committed to delivering exceptional patient and family experiences. The Manager of Coding Quality, Audit & Education leads coding accuracy, audit oversight, regulatory compliance, and coder and physician education across inpatient, outpatient, and professional services. The role oversees coding audits and education programs, manages audit and education staff, and serves as a subject matter expert on coding regulations and documentation standards.
Responsibilities
- Develops and provides educational and training programs in partnership with the Office of Compliance & Privacy regarding elements of the coding compliance program, such as appropriate documentation and accurate coding, to all appropriate personnel, including SHC coding staff, School of Medicine (SoM) physicians, providers, billing personnel, and ancillary departments
- Provides training & education to newly-hired and contractor coding auditor & educators; monitors performance of the Coding Audit & Education team, and reports standardized monthly reports to the appropriate Coding Director as well as Revenue Cycle Reporting
- Maintains and updates the Coding Audit Policy in accordance to their respective Coding Audit Program
- Ensure consistent monthly or quarterly audits on all internal coders and contractor coders in accordance with the published Coding Audit Policy
- Conducts and oversees any additional retrospective, prospective, targeted, external, and internal coding audits
- Applies standardized scoring methodology in partnership with the Office of Compliance & Privacy to consistently evaluate coding accuracy and standardize review findings and methodology to report monitoring results
- Prepare final reports and executive summaries of audit review findings and recommendations. Compiles and delivers formal presentations to the various management levels
- Communicates review results to coding department management, SoM Department, coders, coding vendors, coding contractors, and SoM physicians and other providers. Makes recommendations to management based on audit findings
- Evaluates the adequacy and effectiveness of internal and operational audits and education designed to ensure that coding processes and practices lead to appropriate execution of regulatory requirements and guidelines related to coding practices including federal and state regulations and guidelines, CMS (Centers for Medicare and Medicaid Services) and OIG (Office of Inspector General) compliance standards
- Research, abstracts and communicates federal, state, and payor documentation, and coding rules and regulations; stays current with Medicare, Medi-Cal and other third-party rules and regulations, ICD and CPT coding updates, Coding Clinic guidelines; serves as subject matter expert and authoritative resource for Stanford Healthcare
- Assesses medical record documentation to meet coding compliance and other third-party requirements and identifies documentation trends and issues to bring forward to management, physicians and providers, SoM departments/Chairs/Chiefs, Office of Compliance & Privacy, and Clinical Documentation Integrity for resolution
- Assures accuracy and compliance of coding, MS and APR DRG (Medicare Severity and All Patient Refined Diagnosis Related Group), APC (Ambulatory Payment Classification) assignments, ICD-10-CM, Current Procedural Terminology (CPT), and HCPCS
- Serves as a resource for department managers, staff, physicians, and administration to support accurate and ethical coding and documentation standards, clinical concepts, and to gain information and/or clarification on institutional guidelines and regulatory requirements
- Lead audits across inpatient, outpatient, and professional coding environments, and coordinate ongoing monitoring of coding accuracy and documentation adequacy
- Establish risk-based audit priorities grounded in denial trends, volume, regulatory changes, and specialty variation
- Works with Revenue Cycle Academy to update or create educational e-learning webinars for the coding staff or new physician provider onboarding
- Participates in partnership with Office of Compliance & Privacy, education rendered to SoM Department Faculty Meetings
- Participates in multidisciplinary committees/groups within the organization working on code dependent initiatives such as PSIs, Mortality reviews, etc. Provides coding expertise in various forums that impact quality scores and reporting
- Works in conjunction with coding and Office of Compliance & Privacy leadership to administer the compliance work plan / program as it related to correct coding and auditing
- Responsible for the review, governance, and ongoing management of professional unlisted, custom, and special procedure codes used when services do not have a defined CPT or HCPCS code
- The role partners closely with School of Medicine Departments, Service Lines and Destination Service Lines, Hospital and Professional Coding Operations, Charge Description Master (CDM), Strategic Pricing, Compliance, Revenue Integrity, other Revenue Cycle departments, and Finance to support new technologies, emerging procedures, and atypical services across both HB and PB environments
Skills
- * Bachelors Degree in a work-related field / discipline from an accredited college or university. Relevant experience in lieu of degree may be considered (requires approval). Relevant experience in lieu of degree is in addition to the experience requirements for this position
- * 5–7 years of progressively responsible, directly related experience, including at least 2 of those years in coding, auditing, and education
- * EPIC experience is required
- * Clearly demonstrates elevated knowledge and skillset in professional coding and/or outpatient & inpatient hospital coding settings
- * Clearly demonstrates elevated knowledge and skillset in auditing & education within professional coding and/or outpatient & inpatient hospital coding settings
- * Demonstrates ability to analyze problems and issues and understand the regulatory and reimbursement impact of those decisions
- * Demonstrates critical thinking skills; able to assess, evaluate, and teach clinical concepts
- * Ability to communicate effectively in written and verbal formats including summarizing data, presenting results
- * Advanced understanding of regulatory guidelines and official coding advice to ensure policies and procedures are current and compliant
- * Ability to comply with the American Health Information Management Association's (AHIMA) Code of Ethic and Standards of Ethical Coding and applicable Uniform Hospital Discharge Data Set (UHDDS) standards
- * Ability to demonstrate familiarity, knowledge and understanding of the principles and provisions of HIPAA (Health Information Portability Accountability Act)
- * Ability to establish and maintain effective work relationships
- * Ability to manage, organize, prioritize, multi-task and adapt to changing priorities
- * Ability to use computer to accomplish data input, manipulation and output
- * Ability to work effectively both as a team player and leader
- * Ability to demonstrate familiarity, knowledge and understanding of health information systems for computer application to Health Information Management and hospital revenue cycle
- * Advanced knowledge and understanding of ICD-10-CM/PCS & CPT-4 coding conventions expertise to code medical record entries; abstract information from medical records; read medical record notes and reports; select accurate codes for assignment and grouping to appropriate Diagnosis Related Groups
- * Advanced knowledge and understanding of standards and regulations pertaining to the maintenance of patient medical records; medical records coding systems; medical terminology; anatomy and physiology and study of diseases
- * Ability to demonstrate knowledge and understanding of privacy regulations and confidentiality when dealing with confidential information and data
- * CCS - Certified Coding Specialist required
- * Masters Degree in work-related field/discipline preferred
- * 3 or more years in an academic medical center is preferred
- * Experience with auditing software preferred
- * RHIT - Registered Health Information Technician preferred
- * RHIA - Registered Health Information Administrator preferred
- * CPC and/or CCSP - Certified Professional Coder preferred
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