Under limited supervision, the HIM Coding Review Specialist will coordinate, monitor and audit documentation and coding of inpatient and/or outpatient services in all applicable health care settings. Audits will focus on correct assignment of CPT, ICD-9-CM, HCPCS codes; Medicare Risk adjustment, and clinician documentation to ensure that Kaiser Permanente is compliant with all regulatory guidelines and internal controls. Audits will encompass internal practitioners, contracted practitioners, coders, internal facilities and contracted facilities. The HIM Coding Review Specialist will analyze audit results, identify patterns, trends or variations in coding and documentation practices and make recommendations for improvement. When necessary, HIM Coding Review Specialist will initiate corrective action plan to ensure resolution of problem areas identified during auditing and monitoring activity. This position will serve as a liaison with HIM staff, revenue cycle, clinicians, and other regional departments as appropriate. 20% travel to multiple facilities within Portland Metro area and WA.
Essential Functions:
- Conduct medical record inpatient and outpatient coding audits to ensure correct assignment of ICD-9-CM, CPT, HCPCS, HCC/Medicare Risk Adjustment codes, and ensure supportive clinician documentation is present to meet regulatory guidelines and internal controls of KP.
- Monitor coding trends, identify potential training needs and contribute to the development, implementation and completion of corrective action plans for all noted deficiencies.
- Collate audit results, analyze findings, identify patterns, trends and variations in coding and documentation practices, and prepare written audit reports complete with findings and recommendations for improvement.
- Conduct quality reviews of the work of other medical coding staff to ensure compliance with departmental/internal policies and other applicable laws and regulations.
- Utilize query process when code assignments are not straightforward or documentation is inadequate or unclear for coding purposes.
- Perform in a partnership with the Coding Departments, and actively participate with peers in coding in-services, staff meetings, reporting of performance measures, and quality outcome monitors.
- Provide education and/or training as needed when patterns of errors are identified, changes in coding or coding policy occur, or when proactive measures are needed.
- When needed to verify code accuracy fully utilizes resources available such as 3M encoder product, internet medical sites, Coding Clinic or CPT Assistant to research issues that help to apply coding guidelines appropriately and thus ensure accurate code assignment.
- Review bulletins, newsletters and periodicals and attend workshops to stay abreast of current issues, trends, and changes in the laws and regulations governing medical record coding and documentation to mitigate the risk of fraud and abuse and to optimize revenue recovery.
- Contribute to the development and maintenance of procedural documentation for internal controls to assist with coding training, education and compliance materials.
- Maintain audit records and tools for a minimum of ten (10) years to include audit plan for a given year, audit tools, reports (including recommendations) of all audits conducted, and copies of completed corrective action plans.
- This job description is not all encompassing.
Qualifications:
Basic Qualifications:
- Three (3) plus years of conducting coding audits and quality performance measures, preparing audit reports with recommendations, and providing education and feedback to facilitate improvement of documentation and coding.
- Extensive computer experience and ability to learn new computer applications quickly and independently, including: EMR(s), Lotus, Excel, Word, Powerpoint.
- Five (5) plus years of extensive auditing experience with demonstrated ability to provide effective statistical analysis and analytical problem solving preferred.
- Five (5) plus years of coding experience using ICD-9, CPT and HCPCS coding to outpatient and/or inpatient medical records, including Medicare, Medicaid, and third party payor billings preferred.
- Experience with project management functions preferred.
- Advanced degree, such as a bachelor's degree or associate's degree in Health Information Management or Health Care Administration or equivalent preferred.
- RHIA, RHIT, CCS, CCS-P credential from AHIMA, or CPC certification from AAPC (Current maintenance of continuing education/membership is required).
- CHC compliance credential with Health Care Compliance Association preferred. (Current maintenance of continuing education/membership is required).
- Ability to obtain 75% or better on Kaiser Coding Skills Assessment for HIM Coding Review Specialist (final candidates will be assessed as part of interview process).
- Advanced understanding of medical terminology, pharmacology, body systems/anatomy, physiology and concepts of disease processes.
- Extensive knowledge of ICD-9-CM, CPT and HCPCS coding guidelines with knowledge and demonstrated understanding of CMS HCC Risk Adjustment coding and data validation requirements.
- Thorough understanding of government rules and regulations and areas of scrutiny for potential areas of risk for fraud and abuse in regards to coding and documentation
- Ability to manage significant work load, and to work efficiently under pressure meeting established deadlines with minimal supervision.
- Demonstrated ability to communicate clearly and effectively with a wide variety of individuals at all levels of the organization.
- Strong time management and project management skills.
- Fluent in English demonstrating skill and proficiency in oral and written communication skills for representation of clear, concise results.
- Ability to evaluate, analyze, compute, and summarize mathematical statistics related to medical record audits performed with ability to prepare materials to present findings, trends, outcomes preferred. (Ability to turn data into information.)
- Advanced proficiency in use of Microsoft Office Suite of Products and other software programs to manage audit data preferred.
Salary Range:
$25.68-$33.93
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.