Medical Documentation Auditor

2 weeks ago

Oakland, United States Kaiser Permanente Full time

**Must live in Northern California**

**Job Summary**:
The EIO Medical Documentation Auditor ensures accurate and complete documentation through compliance and encounter audits and clinician feedback. Provides documentation feedback to clinicians from E&M, CPT and ICD9 audits conducted by EIO auditors using all state/federal and 3rd party payor regulatory standards for both inpatient and outpatient groups.

**Essential Responsibilities**:

- Core Audit Responsibilities: Using Kaiser Permanente auditing tools, conduct concurrent and retrospective audits of documentation supporting E/M, CPT and ICD9 codes assigned by clinical staff. Researches correct coding practices in relationship to applicable rules, regulations and coding conventions for billing to determine compliance with Federal, State and Kaiser Permanente regulations. Using independent judgment and sensitivity, reviews with individual physicians their audit findings, making suggestions for documentation improvements. Provides feedback to clinicians based on Federal and State government billing and coding guidelines. Plans, schedules and performs comprehensive chart audits to identify operational and regulatory issues related to coding, documentation, and compliance requirements and ensure complete and accurate data capture in compliance with Federal and State requirements.
- Works with Medical Center auditing teams to ensure compliance with Federal, State and Kaiser Permanente requirements. Designs and implements methodologies to ensure accurate and complete E&M, CPT and ICD9 coding audits. Provides technical expertise to Regional and local leadership to identify and resolve coding and chart documentation problems impacting the accuracy and consistency of coded data. Works with local Trainers to address operational processes that hinder encounter data capture. Reads and interprets medical data written by providers.
- Enters audit results into regional audit tools to support quality assurance process, regional analysis and regional training activities. Reviews analytical data and audit findings to identify coding trends and other risk areas. Recommends appropriate actions. Conducts quality assurance reviews. Collaborates in the development and execution of local audit and training plans. Partners with the EIO Managers to identify audit trends and risk areas based on audit findings and data analysis. Assists in developing and implementing policies and procedures / Compliance Audit Standards to ensure compliance with Federal, State and other regulatory requirements. Travel throughout the Northern California region based on operational needs may be required.
- Specific Audit Responsibilities - Claims and Referrals: In addition to the standard auditor accountabilities, the EIO Auditor is also responsible for conducting Claims and Referral audits. Responsible for independently implementing the end to end audit process for claims and referrals following established objectives with expected completion and accuracy goals. Partners with Provider Contracting to assess status of claims based on whether associated vendor is a contracted or non-contracted partner. Negotiation approach will need to be tailored to the type of vendor.
- Manage vendor relationship to get access to documentation which requires client management skills and travel to offsite locations. Develops a strategy to get access to pertinent medical record information and all supporting documents that need to be audited. Conducts audit independently on-site per audit objectives and guidelines.

**Basic Qualifications**:
Experience
- Minimum three (3) years CPT, ICD9 & E&M Coding experience.

Education
- Bachelors 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
- Certified Coding Specialist OR Certified Professional Coder - Hospital Outpatient OR Registered Health Information Administrator OR Registered Health Information Technician OR Certified Professional Coder

**Additional Requirements**:

- Proficient in the use of CPT, ICD9 and HCPCS coding principles.
- Comprehensive knowledge of medical diagnostic and procedural terminology is required.
- Demonstrated ability to constructively and sensitively provide feedback to providers and medical center leadership regarding federal and state coding, medical documentation and compliance guidelines, audit results and risk areas.
- Ability to work with and maintain confidentiality of physician, patient, patient account and personnel data.
- Knowledge of outpatient coding practices at both the clinical and inpatient settings.
- Required knowledge of compliance and regulatory requirements including outpatient CMS regulations.
- Strong interpersonal and excellent written, verbal and presentation skills.
- Demonstrated ability to wo

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