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Clinical Education Consultant

Primary Location Redwood City, California Job Number 1185031 Date posted 09/15/2023
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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).

Essential Functions:

- 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.

Basic Qualifications:
- 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).
Additional Requirements:
- 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.


Preferred Qualifications:
- 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.

Primary Location: California,Redwood City,Redwood City 901 Marshall Administration Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 08:00 AM Working Hours End: 05:00 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: NUE-NCAL-09|NUE|Non Union Employee Job Level: Individual Contributor Department: Oakland Reg - 1950 Franklin - Rgnl MG-Medcare Coding Support - 0206 Pay Range: $104000 - $134530 / 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: Yes, 20 % of the Time 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