Single Path Coding Specialist II (Remote)
Stanford Health Care, Sacramento, California, United States, 95828
1.0 FTE Full time Day - 08 Hour R2653892 Remote USA 108700008 Rev Cycle Single Path Coding Finance & Revenue Cycle Day - 08 Hour (United States of America). This is a Stanford Health Care job.
If you're ready to be part of our legacy of hope and innovation, we encourage you to take the first step and explore our current job openings. Your best is waiting to be discovered.
A Brief Overview The Single Path Coding (SPC) Specialist-Level 2 is an advanced coder responsible for reviewing clinical documentation to extract data and assign appropriate ICD‑10‑CM diagnostic codes, CPT procedure codes and modifiers, group APCs for billing, and process NCCI and payer‑specific edits related to hospital and professional coding. The SPC coding specialist processes codes for surgical encounters and follows the ICD‑10‑CM Official Guidelines for Coding and Reporting, AHIMA Code of Ethics and Standards of Ethical Coding, and all AHA Coding Clinics for HCPCS and AMA CPT Assistant. The specialist serves as a subject‑matter expert in hospital and professional coding, interacting with Patient Financial Services, Patient Billing Office, Revenue Integrity (Charge Description Master) Team, provider teams, and Compliance on a routine basis. Responsibilities include reviewing and resolving medical necessity edits for outpatient surgical encounters, applying modifiers to CPT codes, processing revenue cycle errors, and collaborating on documentation optimization opportunities. When necessary, the specialist assists in designing and implementing workflow changes to reduce coding and billing errors. The SPC Specialist II is distinguished from the I level by mastering more than one specialty and/or possessing coding certification in two specialties.
Locations Stanford Health Care
What You Will Do
Reviews medical record documentation and accurately assigns appropriate ICD‑10‑CM diagnoses, CPT codes and modifiers for both hospital and professional claims.
Validates and processes any medical necessity edits (local or national coverage determinations) for hospital and professional coding.
Processes coding‑related payer‑specific edits for hospital and professional claims.
Communicates effectively with provider teams; serves as an advocate for documentation improvement.
Follows established coding conventions and guidelines set forth by State and Federal regulations.
Monitors Discharged Not Billed accounts and ensures timely, compliant processing of outpatient and inpatient encounters.
Maintains established quality and productivity standards.
Performs responsibilities independently, without direct supervision.
Exhibits strong time‑management, problem‑solving and communication skills.
Demonstrates critical thinking, good judgment and decision‑making.
Shows excellent written and oral communication.
Stays abreast of CMS requirements, NCCI edits, NCDs, LCDs and payer‑specific edit processing to ensure clean claim submission.
Follows all Stanford Health Care policies and procedures.
Attends required system, hospital and departmental meetings and educational sessions, and completes required annual learning programs.
Abides by Joint Commission requirements, including cultural diversity, patient care and safety, emergency management, teamwork, respect, training, safety and quality programs, and National Patient Safety Goals.
Performs duties in accordance with the C‑I‑CARE Standards of the Hospital.
Education Qualifications
Associate Degree in a work‑related discipline/field or an equivalent combination of education and work experience.
Experience Qualifications
Five years; must be proficient in coding surgical encounter specialties.
Currently holds role‑related certifications such as RHIA, RHIT, CCS, CCS‑P, CPC, COC or other coding certification in a specialized area, or CIRCC for advanced Interventional Radiology/Interventional Cardiology coding.
Required Knowledge, Skills and Abilities
Successful completion of the Coder Proficiency Exam (pre‑hire).
Consistently meets department quality and productivity standards.
Develops and maintains collaborative relationships with physicians and clinical professionals.
Adapts to change and ambiguity.
Plans, organizes, prioritizes, works independently and meets deadlines.
Complies with the AHIMA Code of Ethics and Standards.
Establishes and maintains effective working relationships.
Manages, organizes, prioritizes, multi‑tasks and adapts to changing priorities.
Solves technical and non‑technical problems.
Utilizes ICD‑10‑CM/PCS and CPT‑4 coding conventions to code medical record entries; abstracts information; reads medical record documentation.
Works effectively with others.
Knows APC grouping methodology.
Proficient in health information systems such as Epic and 3M 360e Computer Assisted Coding.
Fosters effective working relationships and builds consensus.
Works with individuals at all levels of the organization.
Understands NCCI and other CMS compliance issues.
Knows standards and regulations for maintaining patient medical records, coding systems, medical terminology, anatomy, physiology, and disease processes.
Licenses and Certifications
RHIA – Registered Health Information Administrator
RHIT – Registered Health Information Technician
CCS – Certified Coding Specialist
CPC and/or CCSP – Certified Professional Coder
COC
Blood Borne Pathogens
Category II – Tasks that involve no exposure to blood, body fluids or tissues, but employment may require performing unplanned Category I tasks.
SHC Commitment to Providing an Exceptional Patient & Family Experience Stanford Health Care sets a high standard for delivering value and an exceptional experience for its patients and families. Candidates for employment and existing employees must adopt and execute C‑I‑CARE standards for all patients, families and toward each other. C‑I‑CARE is the foundation of Stanford’s patient‑experience and represents a framework for patient‑centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.
You will do this by executing against our three experience pillars, from the patient and family’s perspective:
Know Me: Anticipate my needs and status to deliver effective care.
Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health.
Coordinate for Me: Own the complexity of my care through coordination.
Equal Opportunity Employer Stanford Health Care Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non‑discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.
Base Pay Scale: Generally starting at $60.15 - $67.75 per hour. The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.
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If you're ready to be part of our legacy of hope and innovation, we encourage you to take the first step and explore our current job openings. Your best is waiting to be discovered.
A Brief Overview The Single Path Coding (SPC) Specialist-Level 2 is an advanced coder responsible for reviewing clinical documentation to extract data and assign appropriate ICD‑10‑CM diagnostic codes, CPT procedure codes and modifiers, group APCs for billing, and process NCCI and payer‑specific edits related to hospital and professional coding. The SPC coding specialist processes codes for surgical encounters and follows the ICD‑10‑CM Official Guidelines for Coding and Reporting, AHIMA Code of Ethics and Standards of Ethical Coding, and all AHA Coding Clinics for HCPCS and AMA CPT Assistant. The specialist serves as a subject‑matter expert in hospital and professional coding, interacting with Patient Financial Services, Patient Billing Office, Revenue Integrity (Charge Description Master) Team, provider teams, and Compliance on a routine basis. Responsibilities include reviewing and resolving medical necessity edits for outpatient surgical encounters, applying modifiers to CPT codes, processing revenue cycle errors, and collaborating on documentation optimization opportunities. When necessary, the specialist assists in designing and implementing workflow changes to reduce coding and billing errors. The SPC Specialist II is distinguished from the I level by mastering more than one specialty and/or possessing coding certification in two specialties.
Locations Stanford Health Care
What You Will Do
Reviews medical record documentation and accurately assigns appropriate ICD‑10‑CM diagnoses, CPT codes and modifiers for both hospital and professional claims.
Validates and processes any medical necessity edits (local or national coverage determinations) for hospital and professional coding.
Processes coding‑related payer‑specific edits for hospital and professional claims.
Communicates effectively with provider teams; serves as an advocate for documentation improvement.
Follows established coding conventions and guidelines set forth by State and Federal regulations.
Monitors Discharged Not Billed accounts and ensures timely, compliant processing of outpatient and inpatient encounters.
Maintains established quality and productivity standards.
Performs responsibilities independently, without direct supervision.
Exhibits strong time‑management, problem‑solving and communication skills.
Demonstrates critical thinking, good judgment and decision‑making.
Shows excellent written and oral communication.
Stays abreast of CMS requirements, NCCI edits, NCDs, LCDs and payer‑specific edit processing to ensure clean claim submission.
Follows all Stanford Health Care policies and procedures.
Attends required system, hospital and departmental meetings and educational sessions, and completes required annual learning programs.
Abides by Joint Commission requirements, including cultural diversity, patient care and safety, emergency management, teamwork, respect, training, safety and quality programs, and National Patient Safety Goals.
Performs duties in accordance with the C‑I‑CARE Standards of the Hospital.
Education Qualifications
Associate Degree in a work‑related discipline/field or an equivalent combination of education and work experience.
Experience Qualifications
Five years; must be proficient in coding surgical encounter specialties.
Currently holds role‑related certifications such as RHIA, RHIT, CCS, CCS‑P, CPC, COC or other coding certification in a specialized area, or CIRCC for advanced Interventional Radiology/Interventional Cardiology coding.
Required Knowledge, Skills and Abilities
Successful completion of the Coder Proficiency Exam (pre‑hire).
Consistently meets department quality and productivity standards.
Develops and maintains collaborative relationships with physicians and clinical professionals.
Adapts to change and ambiguity.
Plans, organizes, prioritizes, works independently and meets deadlines.
Complies with the AHIMA Code of Ethics and Standards.
Establishes and maintains effective working relationships.
Manages, organizes, prioritizes, multi‑tasks and adapts to changing priorities.
Solves technical and non‑technical problems.
Utilizes ICD‑10‑CM/PCS and CPT‑4 coding conventions to code medical record entries; abstracts information; reads medical record documentation.
Works effectively with others.
Knows APC grouping methodology.
Proficient in health information systems such as Epic and 3M 360e Computer Assisted Coding.
Fosters effective working relationships and builds consensus.
Works with individuals at all levels of the organization.
Understands NCCI and other CMS compliance issues.
Knows standards and regulations for maintaining patient medical records, coding systems, medical terminology, anatomy, physiology, and disease processes.
Licenses and Certifications
RHIA – Registered Health Information Administrator
RHIT – Registered Health Information Technician
CCS – Certified Coding Specialist
CPC and/or CCSP – Certified Professional Coder
COC
Blood Borne Pathogens
Category II – Tasks that involve no exposure to blood, body fluids or tissues, but employment may require performing unplanned Category I tasks.
SHC Commitment to Providing an Exceptional Patient & Family Experience Stanford Health Care sets a high standard for delivering value and an exceptional experience for its patients and families. Candidates for employment and existing employees must adopt and execute C‑I‑CARE standards for all patients, families and toward each other. C‑I‑CARE is the foundation of Stanford’s patient‑experience and represents a framework for patient‑centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.
You will do this by executing against our three experience pillars, from the patient and family’s perspective:
Know Me: Anticipate my needs and status to deliver effective care.
Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health.
Coordinate for Me: Own the complexity of my care through coordination.
Equal Opportunity Employer Stanford Health Care Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non‑discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.
Base Pay Scale: Generally starting at $60.15 - $67.75 per hour. The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.
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