Documentation & Data Quality (DDQ) Analyst

at  Sutter Health

POSITION OVERVIEW:

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 coding compliance leader through the accurate development, review, and approval of system processes, directives, and tools regarding regulatory reporting and coding compliance with institutional and non-institutional revenue cycle operation. Fosters strategic relationships within Sutter Health to maintain a culture of compliance, by providing accurate coding compliance guidance and developing and delivering educational communications. A thorough understating of current rules/ regulations/ guidelines/ policies/, coding and billingcompliance, National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and ICD-10-CM/PCS, CPT, and HCPCS is necessary to ensure accurate guidance is provided to those functional teams who rely upon it.
Is responsible for participating in the department’s annual risk assessment and work plan development processes and reviews. This includes project specific risk assessments, development of project objectives, scope, approach, deliverables, and assessment of the adequacy of operational action plans designed to mitigate identified risks. Is also responsible for assisting in investigations to provide subject matter expertise knowledge during an investigation.
Participates in improving the efficient and effective delivery of Ethics and Compliance Services consultative, education, training, a complying with regulatory, system, department and professional standards, participating in department initiatives and internal process improvement projects throughout the institutional and non-institutional revenue cycle and clinical environments, providing input into the enhancement of coding, billing and reporting work flows and tools for the health system.
Job Description:
The person selected for this role must live in the Northern California Sutter footprint and come on site as needed for meetings, trainings, etc.

EDUCATION:

Equivalent experience will be accepted in lieu of the required degree or diploma.
Bachelor’s: Business, Finance, HIM, Education, Clinical Field or related field

TYPICAL EXPERIENCE:

5 years recent relevant experience.

SKILLS AND KNOWLEDGE:

Ability to design and implement regulatory and specialty specific education/ training to a wide variety of professionals including but not limited to professional coders, physicians, clinical documentation improvement specialists, other coding education professionals, non-coding professionals.
High level of expertise in the application of skills related to coding, billing, and reporting compliance.
Thorough understanding of rules/ regulations/ guidelines/ policies/ protocols related to mandatory reporting requirements to OSHPD, coding and coding compliance, including National Coverage Determinations (NCDs), and Local Coverage Determinations (LCDs).
Deep understanding of ICD-9/10-CM/PCS.
Well-developed written, verbal, and interpersonal communication skills, including experience communicating to audiences of clinicians, physicians, health information leaders and practitioners.
Experience performing coding/billing investigations, audits, or reviews.
Computer skills, including business, coding, spreadsheet, presentation, word processing and analytical support applications.
Job Shift:
Days
Schedule:
Full Time

WEEKEND REQUIREMENTS:

None

Please refer the Job description for details