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Coding Quality Specialist I - Coding and Billing - Georgia Region

Location: Atlanta, GA Job Number: 725772 Date posted: 08/09/2018
Description: Coders perform basic ICD-9 and CPT coding validation for assigned ambulatory clinical departments. This entry-level position is great for individuals who are embarking on a coding career. With general supervision, coordinates and conducts validation of / and modification to code assignments. Participates in trend identification and analysis on an ongoing basis, regarding TSPMG practitioners, and additional clinical areas as requested, utilizing established documentation and coding criteria. These include but are not limited to; application of documentation standards; validation of health record completeness; process studies and verification; regulatory, accrediting audits, coding compliance and documentation analysis and validation; etc. Concurrent analysis of coding of Kaiser HMO assigned encounters suggesting coding assistance through interpretation of guidelines, and query/communication to practitioners. Performs validations and prepares queries for practitioners on their medical service / clinical documentations and code assignments to ensure that KPSE (Georgia) receives appropriated reimbursement and conforms to applicable guidelines and regulations (Federal, State, and internal). Travel required less than 5%. Candidates must be committed to maintaining the highest quality and production standards.

Essential Functions:
  • Data/documentation and coding validation and analysis. Authorized to modify assigned codes based on clinical documentation review, coding guidelines and queries / issues requiring clarification by clinician.
  • Participates with some supervision in test environments as UAT candidates (user acceptance testing). Document and present analysis to leadership on a project basis. Supports specialty-specific training to practitioners on documentation of services, appropriate coding of level of service, diagnosis and procedures code assignments through interpretation of appropriate coding guidelines. Supports training at the department, team, or individual level as needed.
  • Maintains up-to-date knowledge regarding professional health information practices, as well as standards and regulatory requirements related to health information management and coding compliance (Federal, State, internal).
  • Supports team members who participate in task force groups regarding health information and coding issues.

  • Basic Qualifications:
    Experience
  • Minimum one (1) year of outpatient direct coding assignment and validation experience this may include coding classes and experience through coding program and practicum/experiential learning.
    Education
  • Minimum two (2) years of college level courses in health information, business administration, information systems, healthcare delivery or other related field with strong preference given to those which included coding curriculum requirements.
  • May substitute degree for years of related experience.
    License, Certification, Registration
  • Must demonstrate knowledge expansion through attainment of AHIMA Coding Credentials within departmental guidelines - including but not limited to CCA, CPC with progression to CCS, and CCS-P **This is a requirement to be considered for advancement within the HIMS Coding Department. Eligibility to advance must be met within two (2) years of hire.

    Additional Requirements:
  • Applicant must pass the internal medical terminology and coding assessments in order to be considered.
  • Excellent interpersonal and communication skills (verbal and written).
  • Strong time management and analytical skills, Ability to meet deadlines.
  • Ability to develop and use spreadsheets (MS Excel).
  • Ability to write reports summarizing identified trends, analysis of findings and recommendations.
  • Ability to follow methodology, sample selections, basic interpretation of results and formulation of appropriate recommendations.
  • Working knowledge of medical terminology, anatomy and pathophysiology.
  • Maintains less than five (5)% error rate within six (6) months of hire.

    Preferred Qualifications:
  • Minimum two (2) years of work experience in an outpatient healthcare setting.
  • Minimum one (1) year of direct experience supporting clinician training related to code selection based on interpretation of documentation and coding guidelines including research, development and delivery of cases in a professional manner.
  • Completion of an AHIMA recognized coding certification program.
  • Current credential as a CCA, CCS-P or CCS through AHIMA.



    Primary Location: Georgia,Atlanta,Regional Office - 9 Piedmont 9 Piedmont Center 34 Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: Varies Working Hours End: Varies Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Non-Union, Non-Exempt Job Level: Individual Contributor Job Category: Administration, Clerical and Support Services Specialty: Administration Department: Revenue Cycle Travel: No
    Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

    External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.
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