Clinical Education Consultant
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Accountable for developing training programs to support accurate and appropriate coding and documentation. Able to deliver high quality training independently for multidisciplinary audiences. Supervises the Data Quality Auditors to ensure planning, scheduling and performance of concurrent and retrospective encounter audits are in accordance with regional compliance and Federal and State requirements. Serves as the local 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).
- Develops training programs that support coding and documentation improvement and address documentation risk areas identified through local and regional audits.
- Provides high quality training with minimal support to improve encounter data capture and coding and documentation accuracy.
- Serves as the expert in supporting the local Coding and Documentation team to meet local objectives and achieve performance goals. Participates in various local committees, e.g. CDI, ROG, PCM, etc.
- Supports the local Coding and Documentation team to address operational processes that hinder encounter data capture. If impact extends beyond the medical center, work with EIO to assure regional resolution.
- Supervises Data Quality Auditors to ensure audits and remediation are performed accurately and timely, and in accordance with regional compliance and Federal and State requirements.
- Reviews audit plan, monitors audit schedules, and auditor accuracy and productivity.
- Assures audit results are entered into regional audit database to support quality assurance process, regional analysis and regional training activities.
- Prepares medical center auditing 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 and ensure completion.
- Partners with EIO Training to develop training materials to address audit trends and risk areas identified based on audit findings and data analysis.
- Provides expertise to Medical Center leadership and Coding and Documentation team on internal and external regulatory requirements (e.g., CMS, NCQA). Works with medical center leadership to provide confidential audits and feedback on an as needed basis.
- Communicates changes to federal and state government billing and coding guidelines to medical center leadership, local Coding and Documentation team, and links the messages between region and the medical center.
- Conducts both Medicare and E/M audits on an as-needed basis. 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.
- Mentors and coaches entry level trainers as appropriate.
- Provides project management support for local coding and documentation initiatives.
- 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.
- NOTE: Travel between Medical Center facilities may be required.
- This job description is not all encompassing.
- Minimum seven (7) years of experience in developing programs and conducting training for diverse audiences with minimal supervision.
- Minimum seven (7) years of coding experience based on Coding Clinic Guidelines for inpatient and outpatient.
- Minimum seven (7) years of experience conducting E/M and Medicare audits.
- Bachelor's degree in business administration, health care, public health, finance, business medical records technology OR four (4) years of experience in a directly related field.
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- Certification in one of the following: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Professional Coder (CPC).
- Demonstrated ability to provide coaching and monitoring of daily activities of a complex teams.
- Demonstrated ability to manage processes from initial planning to successful implementation of plans.
- Demonstrated experience conducting Medical Record audits, analyzing audit results, creating action plans, and implementing corrective actions to address audit finding.
- Demonstrated ability to analyze data to identify trends, root causes, and risk areas, quantify the effects and recommend appropriate actions.
- Ability to work with and maintain confidentiality of physicians, patients, patient accounts and personnel data.
- Strong interpersonal and excellent written, verbal and presentation skills.
- Willingness to be flexible depending upon department and/or physician schedule needs.
- Must be able to work in a Labor/Management Partnership environment.
- Experience using PC applications such as MS Word, Excel, Access, PowerPoint.
- Medical center operations or clinical experience.
- Master's degree in business administration, health care, public health, finance, business medical records technology OR six (6) years of experience in a directly related field.
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