Coding Auditor, Remote (MD,DC, or VA)
Primary Location Hyattsville, Maryland
Worker Location Remote
Job Number 1303135 Date posted 08/28/2024
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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.
Job Summary:
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 Educatorto 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:
Experience
- Minimum five (5) years of DIRECT coding experience is required, including minimum of three (3) years of performing coding audits.
Education
- Associates 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
- Registered Health Information Administrator OR Certified Coding Specialist OR Certified Professional Coder OR Certified Professional Medical Auditor OR Certified Coding Specialist - Physician Based OR Registered Health Information Technician OR Certified Outpatient Coder
Additional Requirements:
- 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.
- 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:
- 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.
- Experience with physician documentation audit experience.
- Experience evaluating coding audits and quality performance.
- Bachelors degree.
Primary Location: Maryland,Hyattsville,New Carrollton Administration
Scheduled Weekly Hours: 40
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri
Working Hours Start: 08:00 AM
Working Hours End: 04:00 PM
Job Schedule: Full-time
Job Type: Standard
Worker Location: Remote
Employee Status: Regular
Employee Group/Union Affiliation: NUE-MAS-01|NUE|Non Union Employee
Job Level: Individual Contributor
Department: New Carrolltn Admin - HealthInforMgmt Administratn - 1808
Pay Range: $83200 - $107580 / 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
Remote: Work location is the remote workplace (from home) within KP authorized states.
Worker location must align with Kaiser Permanente's Authorized States policy.
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
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
