Ensures accurate and appropriate coding and documentation of clinicians through coaching, training and monitoring. Provides documentation training and coaching for clinicians. Monitors training success through encounter audits and assures corrective actions are implemented. Serves as the expert on Official Coding and Documentation Guidelines and other internal and external regulatory requirements (e.g., Centers for Medicare &Medicaid Service (CMS), National Committee for Quality Assurance (NCQA).
• Using independent judgment and sensitivity, coaches individual physicians, reviewing their audit findings, making suggestions for documentation improvements and updating on changes to Federal and State government billing and coding guidelines.
• Delivers coding and documentation training in multiple ways including individual clinician, groups of clinician and departmental meetings.
• Works with local Coding and Documentation team to address operational processes that hinder encounter data capture.
• If impact extends beyond the Service Area, work with EIO to assure regional resolution.
• Acts as communication link regarding changes to federal and state government billing and coding guidelines.
• Provide confidential audits and feedback on an "as needed" basis.
• Support the preparation and performance of medical center auditing analysis.
• Collects data and performs analysis to determine root causes of under or over reporting as well as quantifying the effect of the condition identified in the audit.
• Recommends appropriate actions.
• Partners with Data Quality Auditor and the Service Area Data Quality Teams to identify audit trends and risk areas based on audit findings and data analysis.
• Assures corrective actions are implemented for audit review findings.
• Assists in developing and implementing policies and procedures, compliance audit standards to ensure compliance with Federal, State and other regulatory requirements and assures local compliance with these policies and procedures.
• Accountable for consistently demonstrating the knowledge, skills, abilities, and behaviors necessary to provide superior and culturally sensitive service to each other, to our members, and to purchasers, contracted providers and vendors.
• Through the use of Kaiser systems, specifically Kaiser Permanente Health Connect, researches plans for data gathering and analysis; participates significantly in interpreting analyses and developing action plans accordingly.
• Other Duties as Assigned.
• NOTE: Travel between Medical Center facilities will be required.
• Bachelor's degree in business administration (health care, public health, finance, business medical records technology) preferred.
• High School Diploma or General Education Development (GED) required with equivalent experience.
• Certification in one of the following: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Professional Coder (CPC).
• Minimum five (5) years of experience coding based on Coding Clinic Guidelines for inpatient and outpatient.
• Minimum three (3) years of experience developing and conducting training/educational sessions for diverse audiences.
• Minimum three (3) years experience conducting Medical Record audits.
• Experience conducting medical record audits including analysis and the creation/implementation of action plans that address audit finding.
• Project management experience including design and implementation of audit plans.
• Ability to work with and maintain confidentiality of physician, patient, patient account and personnel data.
• Strong interpersonal and excellent written, verbal and presentation skills.
• Demonstrated ability to work within a team environment and build effective teams.
• Willingness to be flexible depending upon department and/or physician schedule needs.
• Demonstrated ability to review analytical data and audit findings to identify documentation trends and other risk areas.
• Demonstrated ability to develop data requirements and work with analytical groups to extract, organize and analyze coded data.
• Must be able to pass proficiency exam.