3 OPEN POSITIONS
To provide professional services training, consultation, audit & feedback to clinicians on their documentation & coding to ensure the KPMAS receives appropriate reimbursement & conforms to applicable guidelines & regulation. This position is expected to be a Subject Matter Expert in one of the following coding Family Practice Specialties: Internal Medicine, Family Medicine,orPediatrics.
Essential Functions:
- Performs periodic quality provider documentation & coding audits for encounters utilizing KP HealthConnect.Verifies the accuracy, completeness, & precision of ICD-9-CM, CPT-4, & HCPCs coding, including modifiers, units, & other variables impacting workload accountability & billing.This requires independently re-coding the encounter from source documentation, completing supporting worksheets documenting rationale for coding decisions, comparing auditor findings against those generated from the provider, identifying & recording discrepancies, & recording the rationale for changes in coding decisions.Determine that providers & relevant support systems are sufficiently capturing services rendered to patients & to assess compliance with Medicare, & other third party requirements for coding & billing purposes. Provides specialty-specific training to clinicians on documentation of services & appropriate coding of level of service (CPT-4), diagnoses (ICD9-CM), procedures (CPT-4) & HCPCS coding including modifiers, units & other variable impacting workload accountability & billing.This covers all settings of care & includes tips & techniques to help clinicians do this correctly & efficiently in KP HealthConnect. Analyzes audit data & provides summary feedback to individual clinicians, making recommendations for improvement.
- Maintains current knowledge to ensure that KPMAS coding & documentation meets regulatory guidelines & audit standards & results in appropriate reimbursements. Maintains professional competency in professional services coding & documentation requirements.
- Provides input in the development, refinement, & implementation of methods & procedures used to complete audit functions.
- Collaborates with the KP HealthConnect team to develop & implement strategies to make appropriate documentation & coding easier for clinicians.
- Develops training materials & information derived from audit findings for feedback to physicians, other audit staff, & project management.
- Participates in KPHC training by providing a coding course to new providers.
- Excellent command of the ICD-9-CM & CPT-4 classification systems with thorough understanding of the effect of data quality on prospective payment, utilization, & reimbursement for multiple medical professional service specialties.
- Thorough working knowledge of outpatient/hospital/institutional coding in multiple medical specialties.Thorough understanding data systems & reporting for health record coding, abstracting, & performance metrics.
- Advanced understanding of medical terminology, pharmacology, body systems/anatomy, physiology & concepts of disease processes & the link to proper assignment of clinical conditions documented & procedures performed.
- Proficient & in-depth knowledge of ICD-9-CM, CPT & HCPCS & Evaluation & Management coding guidelines.
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Qualifications:
Basic Qualifications:
- Minimum of 4 years of coding experience is required.
- Minimum of 4 years of experience in a health care setting is required.
- Minimum of 2 years of medical terminology required.
- Minimum of 3 years of knowledge of compliance and regulatory requirements is required.
- Associate's degree in health administration or RHIT certification or equivalent years experience is required.
- Formal course training in human anatomy/physiology, medical terminology & medical science is required.
- CPC/CPC-H or CCS/CCS-P required.
- CPMA required within 1 year of employment
- Certified Compliance Specialist (CCP-P) required within 1 year of employment.
Preferred Qualifications:
- Working knowledge of KP HealthConnect, particularly the clinical & billing modules, encoder(s) (i.e., Craneware & Encoder Pro), Microsoft Office Suite & other software products is preferred.
- Experience conducting training/educational sessions for professional staff including preparations of instructional materials is preferred.
- Experience with physician documentation audit experience is preferred.
- Experience evaluating coding audits & quality performance preferred.
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.