Coding Compliance Analyst III

About the role

The position is responsible for advancing the mission of the Ethics and Compliance Services (ECS) in a manner consistent with the values and standards of the compliance profession. Functions as a subject matter expert and hospital facility coding compliance leader through the accurate development, review, and approval of system processes, directives, and tools regarding regulatory reporting and coding compliance with revenue cycle operations.

Fosters strategic relationships within Sutter Health to maintain a culture of compliance by providing accurate hospital facility coding compliance guidance and developing and delivering educational communications. A thorough understanding of current hospital facility rules, regulations, guidelines, policies, coding and billing compliance, National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), ICD-10-CM/PCS, CPT, and HCPCS is necessary to ensure accurate guidance is provided to functional teams.

A CCS credential is required, with an RHIA, RHIT, CDIP, or CCDS credential preferred. The position participates in the department's annual risk assessment and work plan development processes and reviews, including project-specific risk assessments, development of project objectives, scope, approach, deliverables, and assessment of operational action plans designed to mitigate identified risks. Assists in investigations by providing subject matter expertise.

Participates in improving the efficient and effective delivery of Ethics and Compliance Services consultative, education, training, and compliance with regulatory, system, department, and professional standards. Contributes to department initiatives and internal process improvement projects throughout the revenue cycle environment, providing input into the enhancement of hospital facility coding, billing, and reporting workflows and tools for the health system.

Responsibilities

• Design and implement regulatory and specialty-specific education/training for professionals including coders, physicians, clinical documentation improvement specialists, and other coding education professionals.
• Provide high-level expertise in coding, billing, and reporting compliance.
• Ensure thorough understanding of rules, regulations, guidelines, and policies related to mandatory reporting requirements (e.g., OSHPD), coding compliance, National Coverage Determinations (NCDs), and Local Coverage Determinations (LCDs).
• Perform coding/billing investigations, audits, or reviews.
• Utilize computer skills, including business, coding, spreadsheet, presentation, word processing, and analytical support applications.

Requirements

• CCS (Certified Coding Specialist) credential required; RHIA, RHIT, CDIP, or CCDS credential preferred.
• 5 years of recent relevant experience.
• Bachelor’s degree or equivalent experience.

Skills

• Deep understanding of ICD-10-CM/PCS.
• Well-developed written, verbal, and interpersonal communication skills, including experience communicating with clinicians, physicians, health information leaders, and practitioners.
• High level of expertise in coding, billing, and reporting compliance.

Benefits

Eligible positions include a comprehensive benefits package.

Pay

Pay range varies by geographic location:

• California, New Jersey, Washington: $117,436.80 to $176,155.20 annual salary.
• Colorado, Florida, Georgia, Illinois, Michigan, Minnesota, Nevada, North Carolina, Ohio, Oregon, Pennsylvania, Texas, Virginia: $105,705.60 to $158,558.40 annual salary.
• Arizona, Arkansas, Idaho, Louisiana, Missouri, Montana, South Carolina, Tennessee, Utah: $93,953.60 to $140,940.80 annual salary.

Total compensation considers experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is one component of Sutter Health’s comprehensive total rewards program.

Schedule

• Full-time (40 hours per week).
• Shift: Days (Monday - Friday).
• Weekend requirements: None.