Auditor, Coding - Customer Service Center at Kaiser Permanente

Posted in Other 16 days ago.

Type: Standard
Location: silver spring, Maryland

Job Description:
To perform high quality and comprehensive review for each assigned audit in compliance with defined scope and deadlines. Perform clinical documentation and coding audits to ensure the Kaiser Permanente Mid-Atlantic States receives appropriate reimbursement and conforms to applicable guidelines and regulation. Ensures all technical aspects of the assignment of diagnostic and procedure coding is carried out in accordance with established standards and is in compliance with CMS, NCQA, third party payers, other regulatory agencies and Kaiser Permanente policy.

Essential Responsibilities:
  • Performs periodic quality physician and non-physician documentation and coding audits for encounters utilizing Kaiser Permanente HealthConnect. Verifies the accuracy and completeness ofICD10-CM, CPT-4, and HCPCs coding, including modifiers/units and other variables. Independently re-codes the encounter from source documentation, completes supporting worksheets documenting rationale for coding decisions, compares auditor findings against those generated from the provider, identifies and records discrepancies and the rationale for changes in coding decisions. Determine that physicians and non-physicians and relevant support systems are sufficiently capturing services rendered to patients. Ensures compliance with Medicare and other third party requirements for coding and billing purposes.
  • Prepares written audit report for all noted deficiencies and makes recommendations to Coding Manager, HIM director and others as appropriate/requested (i.e. graining, oversight, monitoring, process flows, etc). Conducts trend analyses to identify patterns and variation in coding practices.
  • Assists with development of training material and information derived from audit findings when needed.
  • Maintains current knowledge to ensure that Kaiser Permanente Mid-Atlantic States coding and documentation meets regulatory guidelines and audit standards and results in appropriate reimbursements. Maintains professional competency in professional services coding and documentation requirements
  • Collaborates with the Coding Educator to develop and implement strategies to make appropriate documentation and coding easier for physicians and non-physicians.
  • Performs other duties as assigned or required.

    Basic Qualifications:
  • Minimum five (5) years of DIRECT coding experience is required, including minimum of three (3) years of performing coding audits.
  • Associate's degree in health administration OR RHIT certification OR two (2) years of directly related experience required.
  • High School Diploma or General Education Development (GED) required.
    License, Certification, Registration
  • One of the following: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), Certified Coding Specialist Physician (CCS-P) or Certified Outpatient Coder (COC)required.
  • New Hire: Successful completion of Assessment of Critical Coding Skills and 80% or higher passing score.
  • Annually: Successful completion of Assessment of Critical Coding Skills and 80% or higher passing score.

    Additional Requirements:
  • Strong knowledge of the ICD10 CM and CPT-4 classification systems, HCPCS and Evaluation and Management coding guidelines and thorough understanding of the effect of data quality on prospective payment, utilization, and reimbursement for multiple medical professional service specialties.
  • Thorough working knowledge of outpatient/hospital/institutional coding in multiple medical specialties. Thorough understanding of data systems and reporting for health record coding, abstracting, and performance metrics.
  • Advanced understanding of medical terminology, pharmacology, body systems/anatomy, physiology and concepts of disease processes and the link to proper assignment of clinical conditions documented and procedures.
  • Demonstrated knowledge of and skill in data collection, statistical analysis and/or interpretation.
  • 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 coding and documentation fraud and abuse.
  • Extensive computer experience and ability to learn new computer applications quickly and independently, including: EMR(s), Microsoft Office Suite and other software programs.
  • Ability to independently manage a significant workload and to work efficiently under pressure meeting established deadlines.
  • Excellent time management and project management skills.
  • Abides by the Standards of Ethical Coding as set for by AHIMA and AAPC.
  • Working knowledge of relevant federal and state regulations, Medicare guidelines and compliance issues.
  • Ability to work independently with minimal supervision.
  • Ability to work with and maintain confidentiality of physician, patient, patient account and personal data.

    Preferred Qualifications:
  • Experience with physician documentation audit experience.
  • Experience evaluating coding audits and quality performance.
  • Bachelor's degree
  • Working knowledge of EPIC or similar electronic medical record system, particularly clinical and billing modules, encoder(s) (i.e. Encoder Pro), Microsoft Office Suite and other software products.

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