Medical Documentation Auditor
5 days ago
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: Experience using PC applications such as MS Word, Excel, Access, PowerPoint. Demonstrate experience conducting Medical Record audits and ability to interpret and apply Federal and State regulations, coding and billing 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 work independently with minimal supervision. Ability to prioritize workload and meet deadlines. Ability to read and interpret medical data. Demonstrated ability to work within a team environment. Willingness to be flexible depending upon department and/or physician schedule needs. Demonstrated ability to review analytical data and audit findings to identify coding trends and other risk areas. Demonstrated ability to develop data requirements and work with analytical groups to extract, organize and analyze coded data. Must be able to work in a Labor / Management Partnership environment. Preferred Qualifications: Experience using Epic electronic health record systems preferred. Experience using Web based applications preferred. Medical center operations or clinical experience preferred. COMPANY: KAISER TITLE: Medical Documentation Auditor LOCATION: Oakland, California REQNUMBER: 1308030 External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.
-
Medical Documentation Specialist
3 days ago
Oakland, California, United States Kaiser Permanente Full timeJob OverviewIn this challenging and rewarding role, you will play a critical part in ensuring the accuracy and completeness of medical documentation at Kaiser Permanente. As a Medical Documentation Auditor, you will utilize your expertise in coding principles to conduct audits, provide feedback to clinicians, and identify operational and regulatory issues.
-
Medical Coder Auditor, Senior
5 days ago
Oakland, United States Blue Shield of California Full timeThe Risk Adjustment Coding & Auditing team conducts various on-going audits to ensure our embers' health conditions are accurately captured and coded. . The Senior Medical Coder Auditor will report to the Manager of Medical Coding Auditing. In this r Auditor, Medical, Audit, Coder, Senior, Insurance, Healthcare
-
Medical Coder Auditor, Senior
5 days ago
Oakland, United States Blue Cross and Blue Shield Association Full timeYour Role The Risk Adjustment Coding & Auditing team conducts various on-going audits to ensure our embers' health conditions are accurately captured and coded. . The Senior Medical Coder Auditor will report to the Manager of Medical Coding Auditing. In this role you will be responsible for prospective and retrospective clinical documentation review with an...
-
Medical Coding Expert Lead
2 days ago
Oakland, California, United States Blue Cross and Blue Shield Association Full timeYour Role and ResponsibilitiesThe Risk Adjustment Coding & Auditing team at Blue Cross and Blue Shield Association conducts ongoing audits to ensure accurate capture and coding of members' health conditions. As a Senior Medical Coder Auditor, you will play a crucial role in ensuring compliance with our healthcare organization's standards.Key...
-
Clinical Documentation Integrity Specialist
2 months ago
Oakland, United States CARLE Full timePerforms inpatient chart review to determine appropriate DRG assignment and assures appropriate documentation in the chart to support clinical care provided, including severity of illness and risk of mortality which impacts Case Mix Index and mortality ratings. Coordinates with physicians, nurses, ancillary staff, and the coders in Health Information...
-
Lead Accountant in Medical Technology
6 days ago
Oakland, California, United States Promaxo Full timeAbout PromaxoPromaxo is a pioneering medical imaging and robotics company dedicated to improving patient care. Founded in 2016, we strive to redefine the standard of care through innovative technological solutions.We are seeking a seasoned Lead Accountant to join our finance team, contributing to our mission of enhancing the quality of care and impacting...
-
Lead Healthcare Coding Specialist
3 days ago
Oakland, California, United States Blue Shield of California Full timeAt Blue Shield of California, we are committed to delivering high-quality healthcare services. As a Senior Medical Coder Auditor, you will play a critical role in ensuring the accuracy and integrity of our coding processes.About the RoleThis is an exciting opportunity for a skilled professional to join our team as a Senior Medical Coder Auditor. In this...
-
Medical Travel Therapist
2 days ago
Oakland, California, United States Synergy Medical Staffing Full timeAbout the RoleSynergy Medical Staffing is seeking a medical travel therapist to fill a 13-week assignment in Oakland, California.This opportunity offers a chance to work with patients in need while experiencing new locations and cultures. The ideal candidate will have strong skills in occupational therapy and excellent communication abilities.Key...
-
Senior Medical Professional
3 days ago
Oakland, California, United States Fusion Medical Staffing-Nursing Full timeFusion Medical Staffing-Nursing is a leading healthcare staffing agency, connecting medical professionals with exciting travel opportunities nationwide. We're currently seeking a skilled Registered Nurse to join our team in Oakland, California.About the Role:We're looking for a dedicated and compassionate Registered Nurse to provide high-quality patient care...
-
Oakland, California, United States Fusion Medical Staffing-Nursing Full timeAbout the JobFusion Medical Staffing-Nursing is seeking a dedicated Registered Nurse to join our team as a travel nurse in Labor and Delivery. This opportunity offers a unique chance to make a positive impact while exploring new cities and experiencing diverse healthcare environments.Key ResponsibilitiesCommunicate effectively with physicians, patients, and...
-
IT Security Specialist
3 days ago
Oakland, California, United States The Clorox Company Full timeThe Clorox Company is a leading manufacturer and marketer of household cleaning products. We're committed to growth – for our people and our brands.We're looking for an experienced IT Security Specialist to join our team in this hybrid role. This position will be responsible for supporting the design, planning, and execution of projects against leading...
-
Medical Assistant
3 weeks ago
Oakland, United States Asian Health Services Full timeAsian Health Services, founded in 1974, provides health, social, and advocacy services for all regardless of income, insurance status, immigration status, language, or culture. Our approach to wellbeing focuses on “whole patient health,” which is why we provide more than primary care services, including mental health, case management, nutrition, and...
-
Medical Assistant
3 weeks ago
Oakland, United States Asian Health Services Full timeAsian Health Services, founded in 1974, provides health, social, and advocacy services for all regardless of income, insurance status, immigration status, language, or culture. Our approach to wellbeing focuses on “whole patient health,” which is why we provide more than primary care services, including mental health, case management, nutrition, and...
-
Compliance & Risk Consultant, Expert
3 weeks ago
OAKLAND, United States PG&E Corporation Full timeRequisition ID # 161674 Job Category: Compliance / Risk / Quality Assurance Job Level: Individual ContributorBusiness Unit: Electric EngineeringWork Type: HybridJob Location: Oakland Department OverviewElectric Compliance Governance & Reporting functional area (FA) provides oversight for external electric compliance requirements. This includes ensuring...
-
Medical Litigation Paralegal
4 days ago
oakland, United States GPAC Full timep>Litigation Paralegal We are seeking a skilled and detail-oriented Paralegal to join our legal team. The ideal candidate will have strong organizational skills, experience in legal research, and a deep understanding of court procedures and document preparation. This role involves assisting attorneys with case management, drafting legal documents, and...
-
Oakland, California, United States LHH Recruitment Solutions Full timeSenior Accountant Job OverviewLHH Recruitment Solutions is a leading recruitment agency partnering to hire a Senior Accountant for a challenging opportunity in Oakland, California. Our client highly values candidates with previous non-profit experience.Salary InformationThe estimated annual salary for this position ranges from $75,600 to $83,200, based on...
-
Medical Assistant- Certified
4 days ago
Oakland, United States Northern Light Health Full timeNorthern Light Inland Hospital Department: Primary Care - Oakland Position is located: Inland Family Care Oakland Work Type: Full Time Hours Per Week: 36.00 Work Schedule: 7:30 AM to 5:00 PM This position is eligible for a $3,500 (minus tax) sign on bonus that is paid out incrementally. Summary: Responsible for an emphasis of a team-based approach to patient...
-
Critical Care Nurse Wanted in Oakland
4 days ago
Oakland, California, United States OneStaff Medical Full timeWe are seeking a skilled Critical Care Nurse to join our team at OneStaff Medical. This is an exciting opportunity for a dedicated professional to provide high-quality patient care in the ICU setting.**About the Role:**This 13-week contract position requires a RN with experience in Intensive Care Unit settings. The nurse will work 12-hour shifts, 36 hours...
-
Medication Assistant
8 months ago
Oakland, United States Elder Care Alliance Full timeWho We Are An Elder Care Alliance Community Actual pay decision based on factors including experience, skills and training Do you enjoy working with seniors? Do you want to work in a setting where you are valued and appreciated? Mercy Retirement & Care Center is a vibrant retirement community located in Oakland. We provide senior assisted living,...
-
Oakland, United States Asian Health Services Full timeJob SummaryAmbitious professionals with a passion for strategic financial leadership are invited to join our team at Asian Health Services as Deputy Chief Financial Officer.We offer an exceptional opportunity for growth and professional development in a dynamic healthcare environment. The ideal candidate will possess a strong background in financial...