Clinical Quality Coder II

Sutter Health Coding Specialist

This position conducts review of outpatient medical records using International Classification of Disease Coding ICD-10-CM and Current Procedural Terminology (CPT), Medicare Advantage, ICD-10-CM, and Centers for Medicare and Medicaid Services (CMS) coding and reporting guidelines. Performs medical record reviews to ensure accurate assignment of medical diagnoses and procedures. Responsible for pre-appointment review of each encounter in scope, including Medicare Advantage encounters, to ensure accurate reporting of diagnoses and to alert the physician of potential clinical conditions that may require review. This position will support risk adjustment code validation for CMS and HHS Risk Adjustment models.

Education

• HS Diploma or General Education Diploma (GED)

Certification & Licensure

• CRC-Certified Risk Adjustment Coder OR CPC-Certified Professional Coder OR AHMA or AAPC Coding Certification (CCS-P, CPC, COC or CPC-P)

Typical Experience

• One (1) year of recent relevant experience with CMS-HCC and HHS-HCC risk adjustment coding, including review of pediatric and OB/GYN diagnoses and related documentation requirements.

Skills and Knowledge

• Advanced knowledge of ICD-10 diagnosis coding conventions and requirements, knowledge of Quality Coding Program requirements such as the Medicare Advantage Coding Program/HCC, as well as medical terminology and abbreviations of disease, illness and injury process.
• Proficient use of grouper software and/or coding reference books to assign/validate diagnosis codes.
• National Correct Coding Initiative edits, Coding Clinic and CPT Assignment coding guidelines and the contents of a medical record.
• Ability to work independently, as well as be part of the team, including accomplishing multiple tasks in an environment with interruptions.
• Demonstrated written and verbal communications skills to explain sensitive information clearly and professionally.

Job Shift: Days

Schedule: Full Time

Shift Hours: 8

Days of the Week: Monday - Friday

Weekend Requirements: None

Benefits: Yes

Unions: No

Position Status: Non-Exempt

Weekly Hours: 40

Employee Status: Regular

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.

Pay Range is $35.04 to $52.56 / hour. New Jersey, Washington Pay Range is $35.04 to $52.56 / hour. Colorado, Florida, Georgia, Illinois, Michigan, Minnesota, Nevada, North Carolina, Ohio, Oregon, Pennsylvania, Texas, Virginia Pay Range is $31.54 to $47.30 / hour. Arizona, Arkansas, Idaho, Illinois, Louisiana, Michigan, Minnesota, Missouri, Montana, South Carolina, Tennessee, Utah Pay Range is $28.04 to $42.05 / hour.

The compensation range may vary based on the geographic location where the position is filled. Total compensation considers multiple factors, including, but not limited to a candidate's experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health's comprehensive total rewards program. Eligible positions also include a comprehensive benefits package.