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Sr. Coding Quality Auditor Job in Anaheim, California

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Job Title: Sr. Coding Quality Auditor

Employer:St. Joseph Health
Required Certifications:CPMA,CCS,CCS-P,CPC,CEMC
Required Experience:3 to 4 years
Location: Anaheim 92868, CA, US
Date Posted:2/28/2019
Sr. Coding Quality Auditor
CA Anaheim West Center 200
Anaheim, California

Job Summary:

Under the direction of the Coding Integrity Manager, the Sr. Coding Quality Auditor will assist with the day-to-day operations of the audit department for St. Joseph Heritage Healthcare (SJHH) and multiple divisions. This position will assist with new employee training and ongoing department education as well as assist with the identification, development and delivery of new and ongoing provider education and training related to coding and clinical documentation. In addition, the role conducts independent and collaborative provider audits according to the compliance work plan and develops appropriate documentation to support audit work performed.

The position requires collaboration with various departments e.g., Physician Network Operations, Revenue Cycle, Compliance, Practice Operations, and other key stakeholders necessary to develop and implement training curriculum for prioritized opportunities in assigned departments, lead provider training, analyze and distribute key performance metrics and develop action plans for improvement in collaboration with the provider leadership.

Essential Values-Based, Competencies: Demonstrates values-based competencies in line with the four core values that are the foundation of all activities performed by employees in order to achieve the Mission of the St. Joseph Health System.

Dignity: Demonstrates competence in communication and interpersonal relations.
Excellence: Demonstrates competence in continuous improvement, continuous learning, accountability and teamwork.
Service: Demonstrates competence in customer/patient focus and adaptability.
Justice: Demonstrates competence in community orientation and stewardship.

Essential Functions:

• Provides staff with training and resources on Audit and Education procedures & workflow
• Develops action plans as necessary to resolve knowledge gaps with employees or to address the implementation of new service offerings or code changes.
• Facilitates the collection of information to provide feedback to physicians on audit findings to ensure consistency & accuracy with all coding.
• Maintains up-to-date knowledge of current auditing/coding practices and educates providers on coding/documentation guidelines to ensure regulatory compliance.
• Facilitates education to support Medicare Risk requirements & organization goals.
• Analyze patient medical records to identify procedures and physician diagnoses
• Discern relevant patient details from the medical record based on the guidelines
• Audits medical record documentation to identify undercoded and upcoded services; prepares reports of findings and provides provider education and training on accurate coding practices and compliance issues.
• Initiate communication from the physicians’ offices regarding ambiguous or conflicting patient information that follows strict procedural guidelines
• Mentorship partnering to train new coders and/or new hires by providing education and training Assist in working the QA queue for their assigned client when requested
• Monthly progress meetings to discuss process improvements, updates in technology, along with any job related details
• Communicates any coding updates published in third-party payer newsletters and bulletins and provider manuals to coding and reimbursement staff.
• Reviews results of audits with Coding Manager/Coding Supervisor and individual coders. Works with the Coding Manager/Coding Supervisor to reconcile coding audits and resolve coding issues.

Additional Responsibilities:
• Assists management in identifying and creating standardized workflows
• Researches guidelines and develops presentations as needed by the department
• Creates/develops job aids and cheetsheets for the department and providers
• Assists in creating audit tools
• Reviews EMR templates and identifies areas of improvement for provider documentation
• Attends and presents at Executive Leadership meetings as needed
• Performs all other duties as assigned.

Information Management: Understands fully the requirements to meet HIPAA regulations. Must treat all patient information and data with complete confidentiality and takes all precaution to secure this information.

Risk Management: Cooperates fully in all risk management activities and investigations for WM purposes.

Safety Requirements: Is knowledgeable of, observes and complies with hospital codes of Safe Practice, safety policies and emergency procedures.

Minimum Qualifications:
Associate’s Degree in related healthcare field.

• Requires four (4) years of professional fee inpatient, surgical, outpatient coding, E/M, auditing and related work.
• Requires four (4) years’ experience conducting medical coding provider audits and quality performance measures; preparing audit reports with recommendations; and providing provider education and feedback to facilitate improvement in documentation and coding.

• Valid coding credentials (AAPC/AHIMA) required
• Requires one or any combination of the following credentials: CCS, CCS-P, CPC, CEMC, CPMA

Computer Skills:
• Requires strong typing and computer skills in a Windows environment.

• Demonstrates leadership amongst peers.
• Demonstrates initiative in identifying educational opportunities; able to take the lead on projects when opportunities are identified and creating the necessary documents for education
• Proficient use and extensive working knowledge of billing procedures, application and use of ICD-10, CPT, HCPCS and modifiers using professional coding guidelines consistent with Compliance and Federal Regulations required
• Requires previous experience developing and conducting provider training/education sessions for diverse audiences in individual, group, classroom settings.
• Working knowledge of auditing concepts and principles required.
• Possess confidence with the ability to build credibility and trust.
• Possesses solid analytical skills with the ability to look at the big picture impact, experience with project management a plus.
• Possesses excellent written and verbal communication skills with the ability to express complex issues and situations in clear and understandable terms
• Ability to apply a high standard of coding accuracy.
• Ability to work independently and use critical thinking skills to problem solve.
• Ability to understand and carry out oral and written instructions and to request clarification when needed.
• Ability to operate a PC computer, skill using word processing, strong experience in Excel (e.g., pivot tables), database, e-mail, and Internet applications on a PC in a Windows environment.
• Ability to maintain and enforce confidentiality of sensitive information.
• Ability to respond with flexibility and efficiency to frequent changes in task focus, competing priorities, and multiple deadlines.
• Ability to thoroughly analyze problems, perform research, formulate logical conclusions and/or alternatives, make recommendations, and implement solutions.
• Ability to work quickly and accurately with close attention to detail.
• Ability to compose reports, letters, instructions, emails, and other documents with attention to clarity, tone, composition, and mechanics.
• Ability to motivate, develop and direct people to accomplish objectives.
• Ability to communicate and interact effectively with peers, providers, employees and supervisory staff, and respond appropriately and professionally to challenging situations.

Preferred Qualifications:
Bachelor’s Degree in Management, Health Information Technology, or related field strongly preferred.


• Five (5) plus years’ experience conducting medical coding provider audits and quality performance measures; preparing audit reports with recommendations; and providing provider education and feedback to facilitate improvement in documentation and coding
• Five (5) plus years of professional fee inpatient, surgical, outpatient coding, E/M, auditing and related work preferred.
• Five (5) plus year’s previous experience in coding for multispecialty practice highly desirable.
• Two (2) years’ of experience in professional fee billing methodologies preferred.


• Certified Healthcare Compliance (CHC), Clinical Documentation Improvement Practitioner preferred.
• Current RHIT certification highly desirable.

Computer Skills: IDX experience highly desirable. Allscripts, Advanced Web, Meditech experience a plus.

Environmental Conditions: May include exposure to potentially hazardous material, infectious agents, contact with patients, public and staff.

Physical Requirements: Sitting for long periods of time, bending, reaching, stooping, kneeling, pushing/pulling, lifting/carrying up to 15 lbs., and grasping.

St. Joseph Heritage Healthcare (SJHH) is one of California's most respected medical groups. With over 3,000 employees and 75 locations throughout California, including, Northern California, Orange County, High Desert and Los Angeles County, SJHH has been continually recognized as a leader in quality, customer service and information technology. This kind of success is the result of team work, a commitment to excellence and a strong adherence to the organization's mission, vision and values.

St. Joseph Heritage Healthcare (SJHH) provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, St. Joseph Heritage Healthcare (SJHH) complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

St. Joseph Hospital is an equal opportunity employer


When applying online, please reference job number R290201.

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