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Specialist, Coding Review

Primary Location Clackamas, Oregon Job Number 1202474 Date posted 11/29/2023
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Under limited supervision, the Coding Review Specialist will coordinate, monitor, and perform documentation and coding audits of inpatient and/or outpatient services in all applicable health care settings. Audits will focus on correct assignment of ICD-CM codes as supported by clinical documentation to ensure that Kaiser Permanente is compliant with all regulatory guidelines and internal controls. The Coding Review Specialist will analyze audit results, identify patterns, trends or variations in coding and documentation practices, and make recommendations for improvement. When necessary, this position will recommend corrective action plan(s) to facilitate resolution of discrepancies or problem areas identified during auditing and monitoring activity. This position will serve as a liaison with Clinical Documentation Improvement (CDI), internal coding teams, NW Permanente practitioners or partners, other Revenue Cycle departments, and other national or regional departments as appropriate.

Essential Responsibilities:

  • Perform targeted coding and documentation reviews; identify deficiencies and report findings and recommendations. Ensure that all reviews and audits are based on current ICD-CM coding and documentation guidelines as well as current regulatory requirements. Ensure compliance with internal coding guidance, department policies, and other applicable rules and regulations.

  • Identify trends and patterns; compile audit findings and analyze results; perform root cause analysis to identify system issues that may contribute to coding, documentation, claims or other revenue cycle deficiencies. Prepare a written report of all significant audit findings to include, as appropriate or requested, recommendations (e.g., training, oversight, monitoring, process flow changes, documentation and coding education) specific to internal departments, external facilities, and others.

  • Work in partnership with internal departments on regulatory or internal data validation audits. Partners may include National Compliance, Ethics & Integrity Office, National Compliance Audit Team, and regional Coding Compliance. Assist with performing medical record reviews, compiling results, and analyzing findings.

  • Communicate audit results by written report to leadership. As appropriate, communicate results to other national or regional departments, NW Permanente Group, or others as requested.

  • Assist in developing and, as appropriate, delivering educational and training materials related to results of documentation and coding reviews or pertaining to findings from other regulatory audits.

  • Assist in developing corrective action plans intended to address and prevent discrepant findings identified during documentation and coding reviews or communicated from other regulatory audits.

  • Contribute to developing, composing and maintaining instructional and educational materials. Documentation includes, but is not limited to:  concepts pertaining to coding, documentation and risk adjustment, desk procedures, work flow charts/diagrams and policies.  

  • Routinely collaborate and consult with internal coding teams, CDI, other Revenue Cycle departments, NW Permanente practitioners or partners, and national or regional compliance departments as appropriate.

  • Maintain audit records for a minimum of ten (10) years, to include annual audit plans, audit tools, reports of audit results including recommendations, and documentation pertaining to corrective action plans.

  • Basic Qualifications:


  • Minimum four (4) years combined experience performing diagnosis coding AND conducting documentation and coding audits.

  • Education

  • Bachelor's degree, OR four (4) years of experience in a directly related field.

  • High School Diploma or General Education Development (GED) required.

  • License, Certification, Registration

  • Current maintenance of continuing education and membership conditions for one of the below certifications is required: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Professional Coder (CPC), or other equivalent coding certification through American Health Information Management Association (AHIMA), or American Academy of Professional Coders (AAPC).

  • Additional Requirements:

  • Advanced understanding of medical terminology, anatomy, physiology, organ/body systems, pharmacology and concepts of disease

  • processes.

  • Advanced, applied knowledge of ICD-CM codes, coding conventions and coding guidelines.

  • Working knowledge of medical procedure codes (CPT, HCPCS, ICD-PCS).

  • Applied understanding of principles of reimbursement based on risk adjustment model(s) and hierarchical condition category (HCC).

  • Knowledge of acceptable medical record standards and criteria in the context of risk adjustment data validation (RADV).

  • Demonstrated ability to accurately quantify outcomes, to perform effective statistical evaluation, and to apply analytical problem solving skills.

  • Strong working knowledge of the critical elements of the auditing process.

  • Ability to adapt to changing priorities and different work environments without compromising quality.

  • Fluency in English, with demonstrated proficiency in oral and written communication.

  • Demonstrated ability to communicate clearly and effectively with a wide variety of individuals across all organizational levels.

  • Proficiency with computer business applications, and a working knowledge of electronic medical record (EMR) software. Ability to learn new computer applications quickly and independently to manage audit processes and data (e.g., other EMR systems, physician query application for clinical documentation improvement).

  • With minimal supervision, the ability to successfully manage a significant work load and to work efficiently to meet established deadlines under pressure.

  • Understanding of relevant government rules and regulations, and familiarity with the concepts of preventing potential fraud, waste or abuse as they apply to coding and documentation.

  • Ability to obtain a score of ninety percent (90%) or better on an ICD-CM coding skills assessment. Skills assessment may be included as part of final candidates' interview process.

  • Certified Risk Adjustment Coder (CRC) credential

  • Preferred Qualifications:

  • Minimum five (5) years of coding and/or auditing experience across multiple health care delivery settings (e.g., office/clinic, hospital inpatient, hospital outpatient, ambulatory surgery center).

  • Minimum two (2) years of project management experience in a health care related setting. 

  • Bachelor's degree in a health care related field.

  • Completion of an accredited, baccalaureate level program in Health Information Management (HIM).
  • Primary Location: Oregon,Clackamas,Regional Process Center Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 08:01 AM Working Hours End: 05:01 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: NUE-NW-01|NUE|Non Union Employee Job Level: Entry Level Department: Kaiser Permanente Building - Clinical Doc lmprov Codng Svc - 1008 Pay Range: $62400 - $80740 / year The ranges posted above reflect the location in the job posting. The salary range may vary if you reside in a different location or state than the location posted. Travel: No At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.

    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. Submit Interest