Manager, Acute Coding Quality Review

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect. Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.

Job Summary:

Provides leadership for hospital-based coding auditors/educators within Adventist Health. Leads the implementation and facilitation of ongoing coding audits, reporting, and coding education for acute coding team, vendor coding teams, and other external stakeholders as needed. Manages projects and initiatives related to ensuring coding integrity and maintaining the highest degree of coding accuracy and compliance. Supervises and directs the activities of various levels of assigned personnel utilizing both professional and supervisory discretion and independent judgment. Manages and coordinates adherence to the coding quality review workplan. Performs trending via data analysis to direct efforts for targeted review and education initiatives. Ensures compliance with all applicable federal, state and local regulations, as well as with institutional/organizational standards, practices, coding policies and procedures. Supports revenue cycle compliance program by adhering to policies and procedures pertaining to HIPAA, FDCPA, FCRA, and other laws applicable to business practices. Leads a team that fosters collaboration, focusing on continuous improvement and alignment with long term strategy goals of Adventist Health.

Job Requirements:

Education and Work Experience:

• Bachelor's degree or equivalent combination of education/experience: Required
• Master's degree: Preferred
• Five years' of hospital-based coding, including three years of previous coding audit experience: Required
• One year leadership experience: Preferred

Licenses/Certifications:

• Certified Coding Specialist credential through AHIMA: Required

Essential Functions:

• Manages the coding quality review (CQR) audit/education team to ensure all regularly scheduled and ad hoc quality reviews are completed, in addition to all other team’s daily responsibilities. Ensures all coding education needs are being addressed by coordinating education initiatives to internal and external teams, as well as providing oversight for coding education library and resource materials.
• Oversees the audit appeal process to ensure the integrity and accuracy of all coding reviews. Manages respective team to ensure assigned key performance indicators (KPIs) are met. Ensures all CQR team members maintain up-to-date knowledge of medical terminology, coding guidelines, quality standards, regulatory changes, etc. that affect the audit process.
• Develops, recommends, and oversees the implementation and administration of policies and procedures of respective area. Evaluates process and procedures and coordinates with the leadership team to ensure efficient areas of focus and adhere to federal and local laws and regulations.
• Demonstrates, through plans and actions, a consistent standard of excellence to which all department work is expected to conform. Works with cross-functional team members to identify and solve process issues. Focuses on continuous improvement working with the leaders across the health system with a goal of delivering the highest degree of quality service possible.
• Conducts recurring quality assurance audits and provides coaching sessions/performance reviews in relation to set benchmarks. Completes, reviews, manages and monitors department budget.
• Performs other job-related duties as assigned.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply. Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.

JOB INFO

Job Category: Manager

Job Shift:

Assignment Category: Full-time regular

Pay Range: The estimated base pay for this position is $114,359 to $171,538. Additional individual compensation may be available for this role through differentials, extra shift incentives, bonuses, etc. Base pay is only a portion of the total rewards package, and a comprehensive benefits program is available for qualifying positions. Please contact our Talent Acquisition team for more information.

Hiring Department: RC Coding - Acute

Salary : $114,359 - $171,538