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Coding Quality Specialist – Outpatient

Coding Quality Specialist (Outpatient) (Remote)

Job Type

Full time Day – 08 Hour

Day – 08 Hour (United States of America)

This is a Stanford Health Care job.

A Brief Overview
The Coding Quality Specialist evaluates the adequacy and effectiveness of internal and operational controls designed to ensure that coding processes and practices lead to appropriate execution of regulatory requirements and guidelines related to facility coding including federal and state regulations and guidelines, CMS (Centers for Medicare and Medicaid Services) and OIG (Office of Inspector General) compliance standards. Applies standardized scoring methodology to consistently evaluate coding accuracy and standardizes review findings and methodology to report monitoring results. Communicates review results to department management, coders and other appropriate staff. Makes recommendations to management for corrective action. Serve as a subject matter expert and authoritative resource on interpretation and application of coding rules and regulations and conducts risk assessments of potential and detected compliance deficiencies.

Stanford Health Care

What you will do

  • Adheres to the defined review timeline and coding review protocol standards; assists with development of the monitoring schedule; identifies areas to be reviewed.
  • Applies consistent and standardized compliance monitoring methodology for sample selection, scoring and benchmarking, development and reporting of findings.
  • Conducts risk assessments to define monitoring priorities by evaluating previous findings.
  • Conducts routine retrospective and prospective facility and technical coding reviews, specialized and focused reviews, and other reviews as directed by the Manager and Director of HIMS Coding and Compliance Department.
  • Evaluates the appropriateness of ICD-10(International Classification of Diseases), HCPCS (Healthcare Common Procedure Coding System) and CPT (Current Procedural Terminology) codes; evaluates the appropriateness of DRG (Diagnosis-related Group) and admission assignments; evaluates appropriateness of modifier usage; and performs other related analysis and evaluations.
  • Prepares written reports of review findings and recommendations and presents to management and maintains monitoring records.
  • Researches, 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 the department.

Education Qualifications

  • High School Diploma or GED equivalent

Experience Qualifications

  • Three (3) years of progressively responsible and directly related work experience

Required Knowledge, Skills and Abilities

  • Ability to analyze and develop solutions to complex problems
  • Ability to communicate effective in written and verbal formats including summarizing data, presenting results
  • Ability to comply with the American Health Information Management Associate’s Code of Ethic and Standards
  • and applicable Uniform Hospital Discharge Data Set (UHDDS) standards
  • Ability to establish and maintain effective working relationships
  • Ability to judgment and make informed decisions
  • Ability to manage, organize, prioritize, multi-task and adapt to changing priorities
  • Ability to use computer to accomplish data input, manipulation and output
  • Ability to work effectively both as a team player and leader
  • Knowledge of DRG/APC reimbursement
  • Knowledge of health information systems for computer application to medical records
  • Knowledge of ICD-10-CM & CPT-4 coding conventions to code medical record entries; abstract information
  • from medical records; read medical record notes and reports; set accurate Diagnostic Related Groups
  • Knowledge of standards and regulations pertaining to the maintenance of patient medical records; medical records coding systems; medical terminology; anatomy and physiology and study of disease

Licenses and Certifications

  • CCS – Certified Coding Specialist or
  • RHIT – Registered Health Information Technician or
  • RHIA – Registered Health Information Administrator or
  • CPC and/or CCSP – Certified Professional Coder

These principles apply to ALL employees:

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards 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 (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 $55.99 – $63.06 per hour