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Reporting to Director, Compliance & Oversight, the Health Plan Oversight Auditor supports San Francisco Health Plan's (SFHP) Compliance Program by performing assigned audit, monitoring, and investigative activities. You will execute defined audit procedures, analyzes documentation and data and prepares clear workpapers and reports under established methodologies and supervisory guidance. The Health Plan Auditor partners with internal teams to support regulatory compliance, identify control gaps, and contribute to corrective action efforts while building technical knowledge of managed care compliance and program integrity requirements. Please note that while SFHP supports a hybrid work environment, you are required to be onsite and in-office a minimum of 4 days per month. This is a hybrid position, based in our Downtown San Francisco office. Salary: $78,875 - $91,635 WHAT YOU WILL DO: • Perform assigned audits and monitoring reviews of internal departments, providers, vendors, and delegated entities in accordance with established audit plans, procedures, and timelines., • Examines records, reports, workflows, and supporting documentation to assess compliance with applicable laws, regulations, contracts, and internal policies; identify potential control gaps and documents findings., • Complete audit workpapers, testing documentation, and memoranda that reflect procedures performed, evidence reviewed, and conclusions reached., • Helps develop and execute the Annual Audit Workplan by supporting planning activities, data collection, and issue tracking., • Prepare draft audit reports, summaries, and management reports by collecting, analyzing, and synthesizing operational and compliance data., • Communicate audit status and preliminary findings to the Director and designated stakeholders; participates in meetings to review results and clarify issues., • Investigate leads generated by antifraud and monitoring systems; maintains assigned caseloads and prepares summary documentation for management review., • Support monitoring of SFHP's policies and procedures and apply working knowledge of the policy development and approval process during audit activities., • Assist in the development, documentation, and tracking of corrective action plans (CAPs); support follow-up testing to validate remediation., • Coordinate administrative and logistical support for external audits and regulatory examinations, including document compilation and response tracking., • Participate in the Program Integrity Workgroup and support development of the Annual Program Integrity Workplan and required regulatory reports., • Conduct routine provider, vendor, and member reviews and investigations related to compliance, fraud, waste, abuse, and HIPAA concerns, escalating issues., • Provide support to the Compliance Hotline by assisting with intake, research, and documentation of reported concerns., • Monitor regulatory and industry developments and escalates potential compliance impacts to the Director., • Maintain working knowledge of state and federal healthcare regulations and managed care requirements applicable to publicly funded programs., • Bachelor's degree in business administration, healthcare administration, or a related field, or an equivalent of combined education or experience., • Minimum of three (3) years of experience in healthcare operations, compliance, auditing, or program integrity., • Knowledge of state healthcare programs, regulatory compliance, and antifraud activities., • Professional certification such as Certified Professional Coder (CPC), Accredited Healthcare Fraud Investigator (AFHI), Certified Internal Auditor (CIA), or healthcare compliance certification preferred. WHAT WE OFFER: • Health Benefits, • Medical: You'll have a choice of medical plans, including options from Kaiser and Blue Shield of California, heavily subsidized by SFHP., • Dental: You'll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage., • Vision: Employee vision care coverage is available through Vision Service Plan (VSP)., • Retirement - Employer-matched CalPERS Pension and 401(a) plans, 457 Plan., • Time off - 23 days of Paid Time Off (PTO) and 13 paid holidays. Established in 1997, San Francisco Health Plan (SFHP) is an award-winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco County. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 175,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services. San Francisco Health Plan is proud to be an equal opportunity employer. We are committed to a work environment that supports, inspires, and respects all individuals and in which our people processes are applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristics. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. San Francisco Health Plan is an E-Verify participating employer. Hiring priority will be given to candidates residing in the San Francisco Bay Area and California. #LI-Hybrid (Hybrid remote/in-office) Please see job description PI282612688 Job distributed by ___.

HIMS Per Diem 87476BR Job Summary The Health Information Coder III is a senior-level inpatient coder with the knowledge and skill set to utilize the ICD-10-CM and ICD-10-PCS classification systems to code acute academic, teaching inpatient cases. The skill set extends to knowledge and comprehension of code sequences into Diagnoses-Related Groups on acute academic, teaching inpatient cases. Cases are coded to comply with the official guidelines for coding and reporting, practice standards and code of ethics for HIMS coder. Cases are abstracted according to UCSF Health policies and procedures. The focus of coding and abstracting is on a range of all primary hospital services. There is minimal review of coding for quality. DUTIES AND ESSENTIAL JOB FUNCTIONS • Retrieve and analyze comprehensive medical records and information systems for appropriate documentation and follow-up as appropriate., • Evaluate full episode of care of clinical data for inpatient cases and assign appropriate codes using ICD-10-CM andICD-10-PCS classification systems. Includes assessment of the condition and diagnosis to conclude the coding of clinical data and DRG assignment. Meet external requirements for HCAI, HCFA, The Joint Commission, NCQA and payor data requirements., • Accurately input codes and abstract data into current coding databases., • Participate in coding audits and coding educational sessions and provide feedback and training., • Meet or exceed department production standards for the DRG coding level., • Meet or exceed department quality standards for the DRG coding level., • Maintain knowledge of current medical terminology, disease processes, anatomy & physiology, and current DRG coding guidelines., • Follow-up and clarify physician documentation (dictation and clinical notes)., • Report to a lead or manager., • Interact with internal and external UCSF Health staff and customers., • Demonstrate understanding of DRG coding mission within UCSF Health., • Demonstrate understanding of DRG coding, AR, and data submission information flow., • Ability to solve problems and troubleshoot computer issues., • Perform data searches., • Maintain patient confidentiality and IT security., • Treat others with respect and work well on a team., • As requested, train others., • Follow safety and infection control guidelines., • Maintain equipment and work area, • Comply with the UCSF Health dress code., • Other duties as assigned. The final salary and offer components are subject to additional approvals based on UC policy. Your placement within the salary range is dependent on a number of factors including your work experience and internal equity within this position classification at UCSF. For positions that are represented by a labor union, placement within the salary range will be guided by the rules in the collective bargaining agreement. The hourly rate for this role is $70.02 (Hourly Rate). To learn more about the benefits of working at UCSF, including total compensation, please visit: ___ Required Qualifications • High school graduation., • Certified Coding Specialist (CCS), Certified Inpatient Coder (CIC), Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA) certification, • 3+ years' experience inpatient DRG coding and abstracting in an academic, teaching hospital., • Must pass the initial knowledge assessment test with a score of 86.6%., • Must meet daily production requirement with minimal accuracy rate of 95%., • Basic EHR and encoder skills, • Basic computer skills, including Windows, Word and Excel., • Proven excellent communication and cooperative skills., • Ability to analyze information, make decisions and exercise independent judgment., • Ability to follow written directions., • Ability to prioritize work and manage time effectively., • Ability to meet deadlines and perform well under pressure., • Knowledge of medical terminology, medical abbreviations, disease processes, anatomy and physiology., • Knowledge of HIMS database systems. At UCSF Health, our mission of innovative patient care, advanced technology and pioneering research is redefining what's possible for the patients we serve - a promise we share with the professionals who make up our team. Consistently ranked among the top 10 hospitals nationwide by U.S. News & World Report - UCSF Health is committed to providing the most rewarding work experience while delivering the best care available anywhere. In an environment that allows for continuous learning and opportunities for professional growth, UCSF Health offers the ideal atmosphere in which to best use your skills and talents. Pride Values UCSF is a diverse community made of people with many skills and talents. We seek candidates whose work experience or community service has prepared them to contribute to our commitment to professionalism, respect, integrity, diversity and excellence - also known as our PRIDE values. In addition to our PRIDE values, UCSF is committed to equity - both in how we deliver care as well as our workforce. We are committed to building a broadly diverse community, nurturing a culture that is welcoming and supportive, and engaging diverse ideas for the provision of culturally competent education, discovery, and patient care. Additional information about UCSF is available at ___ Join us to find a rewarding career contributing to improving healthcare worldwide. Equal Employment Opportunity The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected status under state or federal law. Organization Health Job Code and Payroll Title 004733 HEALTH INFO CODER 3 Job Category Administrative Support Bargaining Unit American Federation of State, County and Municipal Employees - Patient Care Technical Unit (AFSCME-EX) Employee Class Per Diem Percentage 20% Location Emeryville, CA Campus Various Work Sites Work Style Fully Remote Shift Variable Shift Length Variable

Key Responsibilities: - Review and analyze medical records to accurately assign codes for diagnoses, procedures, and services - Ensure all codes are in compliance with coding guidelines and regulations - Communicate with healthcare providers to clarify documentation and obtain additional information

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