Manager – Coding Quality, Audit & Education

This is a fully remote position, open to applicants in United States.

📋 Description

• Provide strategic leadership for coding precision, audit oversight, regulatory adherence, and coder/physician education across inpatient, outpatient, and professional services.

• Disseminate changes in coding regulations, policies, and guidelines throughout the health system.

• Act as a coding resource and subject matter expert for Revenue Integrity, physicians, administration, and Stanford Healthcare.

• Develop and deliver coding compliance education and training programs.

• Train newly hired coding auditors and educators, including contractors.

• Oversee the Coding Audit & Education team and report standardized monthly outcomes.

• Maintain and revise the Coding Audit Policy as necessary.

• Ensure regular audits of both internal and contractor coders on a monthly or quarterly basis.

• Conduct and supervise retrospective, prospective, targeted, external, and internal coding audits.

• Implement standardized scoring methodologies and communicate monitoring outcomes.

• Compile audit reports, executive summaries, recommendations, and management presentations.

• Share audit findings with coding management, physicians, providers, vendors, contractors, and departments.

• Assess the effectiveness of coding audits and education in terms of regulatory and compliance outcomes.

• Research and relay updates on federal, state, payer, Medicare, Medi-Cal, ICD, CPT, and Coding Clinic regulations.

• Review medical record documentation to identify trends and resolve issues.

• Ensure accuracy and compliance in coding, including MS and APR DRG, APC, ICD-10-CM, CPT, and HCPCS assignments.

• Lead audits in inpatient, outpatient, and professional coding environments.

• Establish priorities for risk-based audits.

• Create or update e-learning webinars for the Revenue Cycle Academy and physician onboarding education.

• Engage in faculty meetings, multidisciplinary committees, and code-dependent initiatives.

• Manage the compliance work plan/program for accurate coding and auditing practices.

• Govern and oversee professional unlisted, custom, and special procedure codes.

• Collaborate with clinical, coding, compliance, revenue cycle, pricing, and finance departments regarding new technologies, procedures, and atypical services.

⛳️ Requirements

• Bachelor’s Degree in a relevant field from an accredited college or university; relevant experience may be considered in lieu of a degree with proper approval, in addition to the experience requirements.

• Master’s Degree in a relevant field/discipline is preferred.

• 5–7 years of progressively responsible, directly related experience, including at least 2 years in coding, auditing, and education.

• Experience with EPIC is required.

• A minimum of 3 years in an academic medical center is preferred.

• Familiarity with auditing software is preferred.

• Advanced knowledge and skillset in professional coding and/or outpatient and inpatient hospital coding environments.

• Enhanced expertise in auditing and education within coding contexts.

• Ability to analyze problems and comprehend regulatory and reimbursement implications.

• Strong critical thinking skills with the capability to assess, evaluate, and instruct on clinical concepts.

• Proficient written and verbal communication skills, including data summarization and results presentation.

• In-depth understanding of regulatory guidelines and official coding recommendations.

• Commitment to adhering to the AHIMA Code of Ethics, Standards of Ethical Coding, and UHDDS standards.

• Knowledge and comprehension of HIPAA regulations.

• Advanced knowledge of ICD-10-CM/PCS and CPT-4 coding conventions.

• Familiarity with medical records, coding systems, medical terminology, anatomy and physiology, and diseases.

• Understanding of privacy regulations and confidentiality protocols.

• CCS (Certified Coding Specialist) certification is required.

• Certifications such as RHIT, RHIA, CPC, and/or CCSP are preferred.

🏝️ Benefits

• Comprehensive health insurance options.

• Generous retirement plans and employer contribution.

• Opportunities for professional development and continuing education.

• Flexible work arrangements.

• Supportive work environment with a focus on employee well-being.