Audits medical records & provides feedback to physician & non-physician staff for outpatient and/or inpatient professional fee services to ensure that KP Colorado is compliant w/ applicable guidelines & regulations. Builds & maintains a professional relationship w/ internal & external customers. Considers how actions and/or plans will affect internal & external customers; responds quickly to resolve problems & meet customer needs.
Essential Functions:
- Performs audits of documentation & coding of inpatient and/or outpatient professional fee services
- Analyzes results & identifies patterns, trends & variations in coding & documentation practices
- Presents feedback to physician & non-physician staff on documentation & appropriate coding of diagnoses, procedures, modifiers & E&M services & offers recommendations for improvement
- Develops & presents training for physician & non-physician staff at the team or individual level as needed
- Able to interpret & apply national & state coding guidelines to ensure accurate documentation & coding
- Maintains a sustained level of coding accuracy & productivity to support auditing & feedback schedules & comply w/ department standards
- Maintains current knowledge of coding conventions, updates, government regulations & third party billing requirements
- Performs other duties as assigned
- In addition to defined technical requirements, accountable for consistently demonstrating service behaviors & principles defined by the KP Service Quality Credo, the KP Mission as well as specific departmental/organizational initiatives
- Also accountable for consistently demonstrating the knowledge, skills, abilities, & behaviors necessary to provide superior & culturally sensitive service to each other, to our members, & to purchasers, contracted providers & vendors
Qualifications:
Basic Qualifications:
- 4 years of experience in outpatient or inpatient professional coding using ICD-9, CPT-4 & HCPCS to include 2 years of performing coding audits & providing feedback to facilitate improvement of documentation & coding based on the audit results
- HS diploma or equivalent
- AHIMA or AAPC coding certification required
- Internal applicants must maintain a minimum of 6 months of sustained 95% accuracy in their current position in the coding department
- Must pass internal assessment test
- Demonstrated ability to understand the clinical content of a health record including the most complicated records
- Must possess a thorough knowledge of coding conventions, governmental regulations, & third party billing requirements as well as pharmacology indications for drug usage & related adverse reactions, ancillary testing (laboratory, radiology, etc.), anatomy, physiology, & medical terminology
- Excellent written & oral communication skills
- Demonstrated ability to explain, in writing or orally, complex information in a clear, concise, & organized format
- Must be able to work w/ a variety of health care professionals at all levels
- Ability to communicate w/ physician & non-physician staff w/ a commitment to provide quality customer service
- Previous experience using MS Office products to include Excel, Word & PowerPoint
- Familiarity w/ electronic medical record systems required
- Must maintain all certifications required by this position
- Must be able to work independently & in a team environment
- Position requires travel to multiple KP facilities within the Denver Metro area
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.