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Consultant Coding Senior

Primary Location Renton, Washington Worker Location Onsite Job Number 1282321 Date posted 06/19/2024
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Description:
Job Summary:

Ensure that coding and documentation for assigned areas meet Kaiser Foundation Health Plan of Washington compliance and quality standards. Serve as a coding resource to staff throughout Kaiser Foundation Health Plan of Washington. Perform needs assessment and implement coding education for practitioners, ancillary staff, Business Operations and CIS staff. Research complex coding issues and maintain a knowledge base regarding policies and guidelines from CMS and other payers. Teach complex coding issues and concepts. Evaluate medical record documentation against coding and billing compliance standards and provide detailed reports of findings. Develop and implement coding improvement plans. Consult with providers and business office staff to advise on coding issues. Serve as a committee member or project manager for coding issues.



Essential Responsibilities:


  • Conducts performance analysis and needs assessment of complex coding, documentation and compliance issues.

  • Develops, implements and evaluates coding education.

  • Conducts specialized education and classroom training for providers, clinical support staff, and business staff in documentation, billing, compliance and selection of CPT and ICD-9 CM codes.

  • Educates, serves as a resources for and assists with monitoring Coding Review Unit staff in Patient Financial Services. 

  • Develops specialty specific education materials for classroom and individual practitioner training as well as Epic job aids.

  • Communicates complex coding issues to various audiences throughout KFHPW.

  • Serves as the coding, documentation, reimbursement and compliance expert consultant to designated specialty and primary care teams.

  • Demonstrates resource expertise on compliant coding and billing, and regulatory requirements.

  • Researches clinical specialties, coding changes and guidelines, Federal and State health care billing rules and regulatory requirements, and industry-standard billing practices.

  • Based on audit findings, may lead project work, start to finish, around corrective compliance actions, reporting directly to the Compliance Officer and legal counsel.

  • Researches and responds to formal coding and billing appeals.

  • Performs medical record documentation audits of patient care against services and diagnoses reported by providers, following the KFHPW Coding and Billing Quality Plan.

  • Develops audit schedules and monitors audit progress to ensure timelines are met.

  • Reports formal audit findings to Medical Staff and Operations leaders.

  • Develops and implements improvement plan based on audit findings.

  • Designs and maintains medical record forms and charge capture documents.

  • Reviews Epic system set-ups to assure that master files and tools are compliant with coding and billing rules.

  • Makes recommendations to CIS team on changes and enhancements to the Epic system.

  • Acts as a project manager, displaying effective teamwork and leadership skills, setting and meeting deadlines and objectives for projects assigned; leads and participates in committees as requested; effectively collaborates with CBO, Business Operations, CIS and the delivery system.

  • Provides extensive support to the delivery system and business office staff, before, during and after Epic implementation.

  • Identifies coding errors and process issues, provides feedback.

  • Assesses needs and provides appropriate training prior to go-live, provides on-site support during go-live and maintains support and assistance once implementation phase is completed.

  • Assures compliance, assesses and provides appropriate education with respect to accurate and compliant coding in Epic.

  • Evaluates medical record documentation in the electronic record against coding and billing standards and provides detailed reports of findings.

  • Develops processes to assist providers in maximizing Epic efficiencies while maintaining correct coding and compliance.

Basic Qualifications:

Experience


  • Minimum five (5) years of progressively responsible experience in ICD-9-CM, CPT and HCPCS coding in a clinic setting, to include chart auditing experience.


Education


  • Bachelors degree in a health care or education related field OR four (4) years of experience in a directly related field.

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


License, Certification, Registration


  • Certified Outpatient Coder within 1 months of hire OR Registered Health Information Administrator within 1 months of hire OR Certified Professional Coder - Hospital Outpatient within 1 months of hire OR Certified Professional Coder within 1 months of hire OR Certified Coding Specialist within 1 months of hire OR Certified Coding Specialist - Physician Based within 1 months of hire OR Registered Health Information Technician within 1 months of hire



Additional Requirements:


  • Experience in application of compliant coding principles, including Medicare compliance issues.

  • Extensive knowledge of health care billing and reimbursement including industry standard billing rules, Medicare, Medicaid, L&I and commercial insurance.

  • Knowledge of adult learning theory and instructional approaches.

  • Knowledge of medical terminology and medical science and disease processes, anatomy and physiology.

  • Progressively responsible roles in clinical coding, business and training.

  • In-depth knowledge of ICD-9, CPT and HCPCS coding and documentation.

  • Communication, presentation, interpersonal and customer service skills.

  • Conflict resolution and problem solving skills.

  • Leadership skills.

  • Organizational skills.

  • Demonstrated ability to implement up to date and compliant coding information in a complex clinical setting.

  • Computer proficiency in a Windows environment, including MS Word, PowerPoint and Excel.



Preferred Qualifications:


  • Hospital and clinic experience.

  • Minimum seven (7) years of Progressively responsible experience in ICD-9-CM, CPT and HCPCS coding in a multi-specialty practice, hospital professional and hospital facility settings, including chart auditing experience. 

  • Project management experience in handling complex and sensitive compliance projects.

  • Bachelors degree AND additional related work experience preferred.

  • At time of hire CPC or CCS-P.

  • Demonstrated success working with delivery system staff, including creating and delivering formal and informal educational programs.

  • Progressive experience in the application of compliant coding information in a complex clinical setting. 

  • Demonstrated experience in enterprise clinical information systems (EpicCare).

  • EpicCare and Last Word knowledge. 

  • Extensive knowledge of Medicare compliance issues and health care coding, billing and reimbursement in a fee-for-service environment.

  • Knowledge of APCs and DRGs.

Primary Location: Washington,Renton,Renton Administration - Glacier 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 Worker Location: Onsite Employee Status: Regular Employee Group/Union Affiliation: NUE-WA-04|NUE|Non Union Employee Job Level: Individual Contributor Department: Renton Admin Glacier - Medical Records Admin - 1130 Pay Range: $82200 - $106260 / 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 On-site: Work location is on-site (KP designated office, medical office building or hospital). 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