Senior Coding Consultant

6 days ago

Renton, Washington, United States Kaiser Permanente Full time
Job Summary

We are seeking a highly skilled Senior Coding Consultant to join our team at Kaiser Permanente. As a key member of our coding and compliance team, you will be responsible for ensuring that coding and documentation for assigned areas meet Kaiser Foundation Health Plan of Washington compliance and quality standards.

Key Responsibilities
  • Conduct performance analysis and needs assessment of complex coding, documentation, and compliance issues.
  • Develop, implement, and evaluate coding education programs.
  • Conduct 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.
  • Educate, serve as a resource for, and assist with monitoring Coding Review Unit staff in Patient Financial Services.
  • Develop specialty-specific education materials for classroom and individual practitioner training as well as Epic job aids.
  • Communicate complex coding issues to various audiences throughout KFHPW.
  • Serve as the coding, documentation, reimbursement, and compliance expert consultant to designated specialty and primary care teams.
  • Demonstrate resource expertise on compliant coding and billing, and regulatory requirements.
  • Research clinical specialties, coding changes, and guidelines, Federal and State healthcare 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.
  • Research and respond to formal coding and billing appeals.
  • Perform medical record documentation audits of patient care against services and diagnoses reported by providers, following the KFHPW Coding and Billing Quality Plan.
  • Develop audit schedules and monitor audit progress to ensure timelines are met.
  • Report formal audit findings to Medical Staff and Operations leaders.
  • Develop and implement improvement plans based on audit findings.
  • Design and maintain medical record forms and charge capture documents.
  • Review 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.
Requirements
  • 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.
  • Bachelor's degree in a healthcare or education-related field OR four (4) years of experience in a directly related field.
  • High School Diploma OR General Education Development (GED) required.
  • Certified Outpatient Coder within 1 month of hire OR Registered Health Information Administrator within 1 month of hire OR Certified Professional Coder - Hospital Outpatient within 1 month of hire OR Certified Professional Coder within 1 month of hire OR Certified Coding Specialist within 1 month of hire OR Certified Coding Specialist - Physician Based within 1 month of hire OR Registered Health Information Technician within 1 month of hire.
  • Additional Requirements: Experience in application of compliant coding principles, including Medicare compliance issues. Extensive knowledge of healthcare 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.
  • Bachelor's 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 healthcare coding, billing, and reimbursement in a fee-for-service environment.
  • Knowledge of APCs and DRGs.

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