Provide training, consultation, audit and feedback to CDI Specialist and/or clinicians on documentation and coding to ensure that KPNW receives appropriate reimbursement and conforms to applicable guidelines and regulations.
Essential Functions:
- Improves coding specificity by educating CDI Specialist, physicians, clinicians & other involved parties regarding the necessity of providing complete & clear documentation of the care provided throughout a patient's stay. This incl. medical necessity & capturing Hierarchical Conditions Categories during the patient's stay. This is achieved via queries, face-to-face communications, &/or other educ. prgrms & tools useful & necessary to achieve this goal.
- W/in assigned clinical specialties, maintain current knowledge to ensure that KPNW coding & documentation meets regulatory guidelines & audit standards.
- Ability to communicate w/ the individual physician or med. staff departments to facilitate complete & accurate doc. of the inpatient record.
- Serve as a resource for physicians to help link ICD-9-CM or ICD 10 CM coding guidelines & med. terminology to improve accuracy of final code assignment.
- Work in a collaborative fashion to educate these depts via queries, face-to-face communications, &/or other educational prgrms & tools useful & necessary to achieve this goal.
- Ability to work w/ other documentation & coding educators in presenting 20 mins. of material w/in a lunchtime team mtg; as well as up to 4 hrs of med. specialty specific training or as part of the New Hire Clinician training team as pertaining to both physician & facility inpatient documentation.
- Carefully analyzes & chooses educational presentation training points; to ensure training is relevant & meets CDI specialist &/or provider needs appropriately to improve or maintain, consistent & accurate documentation.
- Remains current w/ coding info to ensure accuracy of codes assigned base on documentation.
- Info will include the AHA Coding Clinic publication, pharmacology, laboratory, disease processes & new/emerging technologies.
- Participates in educational prgrms & in-srvcs in order to maintain & exceed excellence in coding skills.
- Researches new diagnostic & procedure codes utilizing CPT4, ICD9-CM or ICD10 -CM & HCPCS codes & assigns codes as appropriate.
- Reviews & verifies component parts of the med. records to ensure the accuracy of diagnostic & therapeutics proced. is complete & conforms to CMS coding rules & guidelines.
- Performs periodic quality audits of documentation & coding to identify gaps between physician queries & final codes in Epic Care.
- Analyzes audit results & provides summary feedback to physician champions & individual clinicians, making recommendations for improvement by providing coding educ..
- Applies consistent coding practice stndrds when conducting chart audits, using good judgment in preparing individualized recommendations for improvement.
- Uses overall audit data results to develop topics for future dept. training opportunities.
- Collaborates w/ the KP HealthConnect team to dev. & implement strategies to make appropriate documentation & coding more efficient for clinicians.
- Participates in developm't of organizational proced. & updates of queries, forms & manuals.
- Helps to designs educ. prgrms which provide educ. for all internal customers in clinical documentation guidelines.
- Is involved in the direction & educ. of all phases of these designs to enhance Clinical Documentation process w/ physicians, staff & consultants.
- Produces rpts as requested & produces as requested mnthly summary rpt of cases reviewed.
- This job description is not all encompassing.
Qualifications:
Basic Qualifications:
- Four (4) years of progressive and in-depth multi-specialty professional services coding experience in assignment of diagnostic and procedural coding.
- Two (2) 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), Microsoft Office Suite and other software programs.
- Associate of Science degree in health information technology or equivalent education or years of experience directly related to the duties and responsibilities.
- 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.
- Advanced understanding of medical terminology, pharmacology, body systems/anatomy, physiology and concepts of disease processes.
- In-depth knowledge of ICD-9-CM, CPT and HCPCS and Evaluation and Management coding guidelines.
- Well versed in Medicare Advantage HCC's.
- Facility/IP coding knowledge.
- Exemplary 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 work-load 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.
- 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.
Preferred Qualifications:
- Five plus (5+) years of extensive auditing experience with demonstrated ability to provide effective statistical analysis and analytical problem solving preferred.
- Two plus (2+) years of multi-specialty professional services coding experience using ICD-9, CPT and HCPCS, Evaluation and Management coding, including Medicare preferred.
- Two plus (2+) years of experience with project management functions and presenting education and training feedback to small and large groups preferred.
- Bachelor's degree in health information management or equivalent education or years of experience directly related to the duties and responsibilities preferred.
- Comprehensive knowledge and proficiency in ICD9-CM, CPT and HCPCS coding preferred.
- Advanced proficiency in use of Microsoft Office Suite of products and other software programs to document and manage audit data preferred.
Salary Range:
$53,420 - $70,580
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.