Organization:

SHSO-Sutter Health System Office-Valley

Position Overview:

Leads inpatient coding, billing compliance, and revenue integrity audits to evaluate regulatory compliance, identify risks, and improve operational effectiveness. Provides subject matter expertise and guidance to coding, CDI, revenue cycle, and operational teams while managing audits from planning through reporting in alignment with Sutter Health values and professional auditing standards.

Key Responsibilities:
Lead inpatient coding, billing compliance, and revenue integrity audits.
Participate in annual risk assessments and audit plan development.
Manage audit engagements, including scope, timelines, budgets, and reporting.
Supervise and develop audit staff.
Provide guidance to coding, CDI, compliance, and revenue cycle teams.
Evaluate coding with regulatory, payer, and organizational requirements.
Identify coding, documentation, and reimbursement risks and recommend improvements.
Prepare audit reports and communicate results to leadership and stakeholders.
Support continuous improvement of audit methodologies, workflows, and tools.

Knowledge & Credentials:
Extensive knowledge of hospital rules, regulations, coding and billing compliance requirements, NCDs, LCDs, and reimbursement methodologies.
Advanced expertise in ICD-10-CM/PCS, CPT, and HCPCS coding systems.
Ability to interpret regulatory guidance and provide accurate recommendations to operational, clinical, and revenue cycle teams.
Required: Certified Coding Specialist (CCS).
Preferred: RHIA, RHIT, CDIP, and/or CCDS credential.

Job Description:

EDUCATION:

• Equivalent experience will be accepted in lieu of the required degree or diploma.
• Bachelor's Degree or equivalent

DEPARTMENT REQUIRED CERTIFICATION & LICENSURE:

• Department: Coding Audit, CCS-Certified Coding Specialist

TYPICAL EXPERIENCE:

• 5 years recent relevant experience

SKILLS AND KNOWLEDGE:

• Firm understanding of audit theory and processes and of the professional practice standards of internal auditing as well as core control frameworks.
• Advanced analytical and project management skills, including the ability to analyze data and information, reach practical conclusions, recommend corrective actions, resolve conflicts, and institute effective changes.

Ability to:

• work independently, as well as part of a multidisciplinary team, while demonstrating excellent organization skills.
• manage multiple priorities/projects simultaneously, sometimes with rapidly changing priorities.
• maintain audit/project schedules.
• meet tight and often conflicting deadlines.
• analyze possible solutions using precedents, existing departmental guidelines and policies, experience and good judgment to identify and solve standard problems.
• maintain strict confidentiality and ensure the privacy of each patient’s protected health information (PHI).
• build collaborative relationships with peers, other departments, stakeholders, and external agencies.
• Able to display a high degree of professionalism and leadership.
• Excellent verbal and written communication, interpersonal, and presentation skills with the ability to explain complex technical or sensitive information related to audit activities clearly and professionally to diverse audiences.

Job Shift:

Days

Schedule:

Full Time

Days of the Week:

Monday - Friday

Weekend Requirements:

None

Benefits:

Yes

Unions:

No

Position Status:

Exempt

Weekly Hours:

40

Employee Status:

Regular

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

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.