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Job Summary:Plans, coordinates, and conducts concurrent and retrospective quality reviews or audits related to coding and/or clinical documentation integrity (CDI) functions and work performance impacting billing, and data reporting.Develops and educates the coding and CDI staff, as well as physicians if necessary, in understanding the coding and clinical documentation requirements for diagnosis capture, in alignment with regulatory standards and coding guidelines. Provides expert advice to facility and regional groups to develop, implement and monitor procedures that support organizational goals and business objectives related to the Revenue Cycle, Encounter Information Operations (EIO) Audit Programs.Assures compliance with regional and national coding policies and procedures. Plans, performs or supervises audits. Develops an audit corrective action plan for improvement and monitors compliance with the plan. Assists with coding and CDI questions, provides guidance memos on coding and clinical documentation related issues/topics. Develops and presents coding educational in-services and seminars to the regional coding staff, CDI staff, and others as directed and as needed.Essential Responsibilities:
Quality Audits and Reviews
Coordinates monitors and audits all lines of hospital business for coding and clinical documentation integrity, to include: all outpatient, inpatient, HOV, ED and Ambulatory surgery cases.
Monitors the accuracy and quality of coding and CDI assignments, Present on Admission (POA) indicators and conducts internal coding audits.
Acts as the regional coding contact person for the HIM department to support education and coding requirements.
Develops and presents reports of audit results to Regional and facility staff and Senior Management.
Helps set the direction for coding and compliance education and focused projects related tothe electronic medical record.
Provide oversight and training for Coding Compliance Software to the coding staff.
Run audit selection lists and reports as well as providing education, feedback and guidance based upon data mining activities, processes and clinical documentation requirements.
Monitoring and Reporting
Monitors and coordinates coding and clinical documentation integrity audit activities.
Develops reports of audit findings as required for operational, compliance and risk reporting.
Conducts data and root cause analysis, provides feedback and shares findings to revenue cycle leaders and others as appropriate.
Prepares statistical and annual reports as requested by Revenue Cycle leadership, state or federal agencies or any others.
Develops, maintains, and communicates up-to-date and accurate coding and clinical documentation guidelines and policies to all impacted parties.
Coding and Clinical Documentation Education and Training
Supports the regional coding and clinical documentation audit, education, and training needs of the region.
Conducts exit conferences on audit findings for the coding and CDI staff and management.
Provides education and training on coding and documentation issues identified during audits and reviews.
Collaborates with the coding and CDI management staff in the developing programs which provide alignment with education for internal customers to enhance clinical documentation and comply with coding guidelines.
Audit Coordination
Coordinates with the coding and CDI management in planning and performing coding and documentation reviews for effective and timely completion of work.
Collaborate with the Revenue Cycle Business Risk Management and other compliance and risk management units in identifying risk areas in coding and clinical documentation based on audit findings.
Functions as a liaison for other departments regarding coding and CDI audit questions and issues.
Compliance
Performs audits and reviews in conformance with established policies and procedures and in compliance with federal, state and local regulations.
Consistently supports compliance and the Principles of Responsibility (KPs code of conduct) by maintaining confidentiality, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable Federal and State laws and regulations, accreditation and licensure requirements, and KP policies and procedures.
Accountable for consistently demonstrating service behaviors and principles defined by the Kaiser Permanente Service Quality Credo, the KP Mission as well as specific departmental/organizational initiatives. Also accountable for consistently demonstrating the knowledge, skills, abilities, and behaviors necessary to provide superior and culturally sensitive service to each other, to our members, and to purchasers, contracted providers and vendors.
Kaiser Permanente conducts compensation reviews of positions on a routine bsis. At any time, Kaiser Permanente reserves the right to reevaluate and change job descriptions, or to change such positions from salaried to hourly pay status. Such changes are generally implemented only after notice is given to affected employees.
Basic Qualifications:
Experience
Minimum of 5 (five) years of acute care, inpatient, outpatient, DRGs, HCCs and APCs coding required.
Minimum of 2 (two) years of acute care, inpatient, outpatient, DRGs, HCCs and APCs auditing required.
Education
Associates Degree in Health Information Management, Business Administration, Healthcare Administration, or other related field OR Two (2) years experience in a directly related field.
High School Diploma or General Education Development (GED) required.
License, Certification, Registration
Certified Coding Specialist OR Registered Health Information Administrator Certificate OR Professional Coder Certificate OR Registered Health Information Technician Certificate
Additional Requirements:
Understanding of state/federal regulations that impact coding and reimbursement.
Demonstrated strong interpersonal and communication skills.
Provide high quality in-service and seminar of coding and coding related topics and clinical documentation integrity.
Working knowledge of Hierarchical Condition Category (HCC) coding and reimbursement methodology.
Current knowledge of ICD and CPT coding systems.
Knowledge of computerization and technological advances in health information.
Familiarity with important areas such as privacy, security and confidentiality impacting sharing of clinical information.
Must be able to work in a Labor/Management Partnership (union) environment.
Preferred Qualifications:
Minimum one (1) year experience using electronic health records (EHR).
AHIMA Certified ICD-10 trainer preferred.
CCDS credential preferred.
CDIP credential preferred.
Bachelors Degree in Health Information Management, Business Administration, Healthcare Administration or other related field.
COMPANY: KAISERTITLE: Clinical Documentation Revenue ConsultantLOCATION: Oakland, CaliforniaREQNUMBER: 1254590External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.
