Kaiser Permanente · 8 hours ago
Documentation Quality Auditor IV (NCAL residency required)
Oakland, CA
Full-time
Onsite
Mid, Senior Level
5+ years expKaiser Permanente is a leading health care organization, and they are seeking a Documentation Quality Auditor IV to contribute to coding quality audits and ensure compliance with regulatory requirements. The role involves conducting audits, report writing, and enhancing coding integrity through collaboration and the development of new processes.
Health CareHospitalMental HealthNon ProfitPersonal Health
Responsibilities
Promotes learning in others by proactively providing and/or developing information, resources, advice, and expertise with coworkers and members; builds relationships with cross-functional/external stakeholders and customers. Listens to, seeks, and addresses performance feedback; proactively provides actionable feedback to others and to managers. Pursues self-development; creates and executes plans to capitalize on strengths and develop weaknesses; leads by influencing others through technical explanations and examples and provides options and recommendations. Adopts new responsibilities; adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; champions change and helps others adapt to new tasks and processes. Facilitates team collaboration to support a business outcome
Completes work assignments autonomously and supports business-specific projects by applying expertise in subject area and business knowledge to generate creative solutions; encourages team members to adapt to and follow all procedures and policies. Collaborates cross-functionally and/or externally to achieve effective business decisions; provides recommendations and solves complex problems; escalates high-priority issues or risks, as appropriate; monitors progress and results. Supports the development of work plans to meet business priorities and deadlines; identifies resources to accomplish priorities and deadlines. Identifies, speaks up, and capitalizes on improvement opportunities across teams; uses influence to guide others and engages stakeholders to achieve appropriate solutions
Contributes to audit analysis and report writing by: comparing coding and documentation across the enterprise to identify potential risks and remedies independently; conducting trend analyses to identify patterns and variations in coding practices, key compliance drivers, liabilities, and performance indicators (e.g., adherence to standards, incorporation of new regulations), and beginning to coordinate team members to do the same; and preparing written and/or generated audit reports using standardized language detailing all noted opportunities, and providing education as needed
Contributes to coding quality audits by: conducting special projects, audits, reviews, and/or monitoring of assigned lines of business or scope independently to monitor the accuracy and quality of coding and documentation; using processes to assess accuracy and completeness of coded documentation integrity; and following guidelines and procedures to ensure special projects, audits, reviews, and/or monitoring align with state and federal regulatory and reimbursement requirements, current documentation, and coding guidelines, and guiding team members to do the same
Ensures compliance by: following national, state, and KP-specific coding, billing, and documentation guidelines/guidance for KPs leadership, attorneys, physicians, coders, compliance, and billers to help coordinate consistent and accurate implementation and compliance with external regulations; attending national committees; and participating in National Compliance programs to assure maximum utilization of coding resources when conducting special projects, monitoring, reviews, and/or audits
Contributes to enhancing coding integrity by: assisting with the identification of coding/documentation trends and opportunities; leveraging expert knowledge to aid teams in their assigned lines of business or scope in developing, implementing, and monitoring new processes and workflows that support regulatory needs and requirements, organizational goals, and business objectives; and leading the process of communicating up-to-date and accurate regulation, policy, and guideline changes impacting coding and documentation to all impacted employees
Qualification
Required
Minimum two (2) years of experience in International Classification of Diseases (ICD)-10-Clinical Modification, Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) coding, including chart auditing, applying diagnoses and/or procedure coding, and/or conducting coding reviews
Associates degree in Health Information Management, Health Care Administration, or related field AND minimum five (5) years of experience in health care compliance, health care operations (quality, risk), audit, insurance/health plan governance, coding, medical record review, or a directly related field OR Minimum six (6) years of experience in health care compliance, health care operations (quality, risk), audit, insurance/health plan governance, coding, medical record review, or a directly related field
Registered Health Information Technician required at hire OR Certified Coding Specialist - Physician Based required at hire OR Registered Health Information Administrator required at hire OR Certified Professional Coder required at hire OR Certified Coding Specialist required at hire
Preferred
Risk Adjustment Certification
Five (5) years of auditing experience
Company
Kaiser Permanente
Kaiser Permanente is a health organization that offers disease prevention, mental healthcare, and chronic disease management services.
10001+ employees
Funding
Current Stage
Late StageTotal Funding
$7.48M2018-07-17Grant· $0.08M
2014-08-05Grant· $7.4M
Leadership Team
Gregory Adams
Chair and Chief Executive Officer
James L. Robinson III
Senior Vice President/Area Manager
Recent News
2026-01-23
2026-01-23
2026-01-21
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