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Kaiser Permanente · 5 months ago

Coding Compliance Auditor - Maui Health

Wailuku, HI

Full-time

Onsite

Mid Level

4+ years exp

Kaiser Permanente is a health care organization seeking a Coding Compliance Auditor to coordinate, monitor, and audit documentation and coding for inpatient and outpatient services. The role involves ensuring compliance with regulatory guidelines, analyzing audit results, and providing education and training related to coding practices.

Health CareHospitalMental HealthNon ProfitPersonal Health

Comp. & Benefits

Responsibilities

Reviews and audits coders based on federal regulatory requirements [e.g. the Centers for Medicare and Medicaid Services (CMS)] and current documentation and coding guidelines, as well as ensuring compliance with departmental/internal policies and other applicable laws and regulations

Prepare written audit report for all noted deficiencies and make recommendations to Coding and Revenue Cycle Compliance Manager, HIM director and others as appropriated/requested (i.e. training, oversight, monitoring, process flows, etc.). Conducts trend analyses to identify patterns and variations in coding practices and case-mix index

Develop and deliver education and training programs related to results of document and coding reviews, and findings from RAC and other regulatory audits

Compares coding and reimbursement profile with regional and national norms. Reviews coding claim denials and rejections

Receives and investigates reports of compliance violations. Communicates results to HIM director and compliance officer. Ensures appropriate dissemination and communication of all regulation, policy, and guideline changes to affected personnel

Qualification

ICD-10 codingCPT codingHCPCS codingCertified Coding SpecialistInpatient coding experienceOutpatient coding experienceMedical terminologyStatistical analysisQuality managementCustomer serviceProject managementOral communicationWritten communicationProblem solvingTeamwork

Required

Minimum four (4) years inpatient coding experience in an acute care setting, including experience with ICD-10, ICD-9-CM, CPT4 and HCPCS coding systems, UHDDS definitions, and other related documentation requirements

Bachelors degree in healthcare, health information management or related field OR four (4) years of directly related experience

Certified Coding Specialist from American Health Information Management Association OR Registered Health Information Administrator from American Health Information Management Association OR Certified Professional Coder from American Academy of Professional Coders OR Registered Health Information Technician from American Health Information Management Association

Must possess a proficient understanding of the Inpatient and Outpatient Prospective Payment Systems (IPPS/OPPS), Medical Severity Diagnosis-Related Groups (MS-DRG), and National Correct Coding Initiative Edits (NICCI), ICD-CM Official Guidelines for Coding and Reporting and Coding Clinic

Working knowledge of relevant federal and state regulations, Medicare guidelines, and compliance issues

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

Demonstrated knowledge of and skill in data collection, statistical analysis, and/or interpretation

Demonstrated knowledge of and skill in oral communication, written communication, problem solving, analysis, project management, quality management, systems thinking, group presentations, group process facilitation, influence, and customer service

Demonstrated knowledge of and skill in word processing, spreadsheet, and database PC applications

Demonstrated knowledge of and skill in decision making, customer service, influence, interpersonal relations, oral communication, problem solving, project management, quality management, results orientation, systems thinking, teamwork, written communication, team building/leadership, and change management