Manager - Coding Quality, Audit & Education

A Brief Overview

The Manager of Coding Quality, Audit & Education provides enterprise leadership for coding accuracy, audit oversight, regulatory compliance, and coder/physician education across inpatient, outpatient, and professional services.

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.