Provide training, consultation, audit and feedback to clinicians on their medical service documentation and coding to ensure that KPNW receives appropriate reimbursement and conforms to applicable guidelines and regulations.
Essential Functions:
- Provides expert consultation to specialists or primary care clinicians as assigned on coding and documentation questions.
- Within assigned clinical specialties, maintain current knowledge to ensure that KPNW coding and documentation meets regulatory guidelines and audit standards.
- Sequences all codes appropriately using coding rules and guidelines.
- Researches new diagnostic and procedure codes utilizing CPT4, ICD9-CM and HCPCS codes and assigns codes as appropriate.
- Reviews and verifies component parts of the medical records to ensure the accuracy of diagnostic and therapeutics procedures is complete and conforms to CMS coding rules and guidelines.
- Ability to present twenty (20) minutes of material within a lunchtime team meeting.
- Carefully analyzes and chooses educational presentation training points to emphasize to ensure training is relevant and meets provider needs appropriately to improve or maintain, consistent and accurate provider code selection.
- Performs periodic quality audits of documentation and coding in EpicCare.
- Analyzes audit results and provides summary feedback to individual clinicians, making recommendations for improvement by providing coding education.
- Creates and maintain tools to audit professional coding service data.
- Applies consistent coding practice standards when conducting chart audits, using good judgment in preparing individualized recommendations for improvement.
- Provides on-site specialty specific training to individuals or groups of clinicians regarding documentation of services and appropriate coding of level of service, diagnoses, and procedures; including tips and techniques to help clinicians work more efficiently in EpicCare.
- Contributes to the development and maintenance of specialty-specific coding education materials.
- Responds to or clarifies internal requests for coding information.
- Collaborates with the EpicCare team to develop and implement strategies to make appropriate documentation and coding more efficient for clinicians.
- Reviews and verifies information (such as POS, attending provider) to make sure the transaction of medical data is complete and accurate.
- Participates in development of organizational procedures and updates of forms and manuals.
- Willingness to work evenings or weekends to meet client goals.
- Perform other duties as requested.
- This job description is not all encompassing.
Qualifications:
Basic Qualifications:
- Three (3) years of progressive multispecialty professional services coding experience in assignment of diagnostic and procedural coding.
- One (1) year of experience conducting coding audits and quality performance measures, preparing audit reports with recommendations, and providing education and feedback to facilitate improvement of documentation and coding.
- Moderate computer experience and ability to learn new computer applications quickly and independently, including: EMR(s), Microsoft Office Suite and other software programs.
- Three (3) plus years extensive auditing experience with demonstrated ability to provide effective statistical analysis and analytical problem solving.
- One (1) plus years of multispecialty professional services coding experience using ICD-9, CPT and HCPCS, and Evaluation and Management coding, including Medicare preferred.
- One (1) plus years of experience with project management functions and presenting education and training feedback to small and large groups preferred.
- Experience training small and large groups preferred.
- Associate of Science Degree in Health Information Technology or equivalent education or years of experience directly related to the duties and responsibilities.
- Associate of Science Degree in Health Information Technology preferred.
- Register Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist Professional (CCS-P) from AHIMA or Certified Professional Coder (CPC) from AAPC.
- 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.
- Ability to conduct coding audits to evaluate quality performance measures and using the findings create written reports with recommendations and then present education and feedback to facilitate improvement of documentation and coding.
- Thorough understanding of medical terminology, pharmacology, body systems/anatomy, physiology and concepts of disease processes.
- Thorough knowledge of ICD-9-CM, CPT and HCPCS and Evaluation and Management coding guidelines.
- Good attention to detail and completeness with a 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 a significant workload, and to work efficiently under pressure meeting established deadlines with limited supervision.
- Communicates in a clear and understandable manner; exercises independent judgment.
- Influences and coordinate the efforts of others over whom one has no direct authority.
- Attends workshops to keep abreast of current trends and changes in the laws and regulations governing medical record coding and documentation to minimize the risk of fraud and abuse and to optimize revenue recovery.
- Abides by the Standards of Ethical Coding as set forth by AHIMA and AAPC.
- Knowledge and proficiency in ICD9-CM, CPT and HCPCS coding preferred.
- Meets department standards for performance and quality - Maintains a 98% accuracy rate. Failure to do so would cause a drop in job level.
- Final candidate will be required to obtain 75% or better on Kaiser Coding Skills Assessment for the Senior Coding Consultant.
Salary Range:
$23.91-$30.12
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.