Northwest Permanente, P.C., is a self-governed, physician-led, multispecialty group of over 1,500 physicians, surgeons, and clinicians, caring for over 600,000 members in Oregon and Southwest Washington. Kaiser Permanente is one of the nation's preeminent health care systems, a benchmark for comprehensive, integrated, and high-quality care.
The Documentation and Coding Consultan 1 provides training, consultation, review, and feedback to clinicians on their medical service documentation and coding to ensure KPNW receives appropriate reimbursement and conforms to applicable guidelines and regulations.
Major Responsibilities / Essential Functions
Consulting and Coding services
- Provides expert consultation to specialists or primary care clinicians as assigned on coding and documentation education and questions.
- Within assigned clinical specialties, maintain current knowledge to ensure that KPNW coding and documentation meets regulatory guidelines and audit standards.
- Follow coding specificity guidelines using coding rules and guidelines.
- General coding knowledge and understanding of Risk Adjustment models and submission guidelines for reportable diagnoses.
- Researches new diagnostic and procedure codes utilizing CPT4, ICD-10 and HCPCS codes and assigns codes as appropriate, utilizing Consultant II, Consultant III, Supervisor expertise in decision making.
- Reviews and verifies component parts of the medical records to ensure the accuracy of diagnostic and therapeutic procedures is complete and conforms to CMS coding rules and guidelines.
- Provides face to face or virtual training to clinicians as requested.
- Carefully analyzes and chooses educational presentation training points to emphasize; to ensure training is relevant and meets clinician needs appropriately to improve or maintain, consistent and accurate clinician code selection. Must be able to articulate and understand differences in clinician teaching methodology vs. coder teaching methodology.
- Collaborates with team members when code assignment is not straightforward, or documentation is inadequate, ambiguous, or unclear for coding purposes, utilizing departmental resources and processes.
Data review and Analysis
- Performs periodic quality reviews of documentation and coding in KP HealthConnect/ EpicCare.
- Analyzes results and provides summary feedback to individual clinicians, making recommendations for improvement by providing coding education.
- Enter data into tracking tools to store professional coding service data.
- Applies consistent coding practice standards when conducting chart reviews, using good judgment in preparing individualized recommendations for improvement.
- Uses overall chart review data results to develop topics for future department training opportunities.
- Utilize data to identify trends and patterns for focus of educational opportunities. Analyze findings and identify root cause analysis.
- On request by clinicians, provides on-site or virtual specialty specific training to individuals or groups of clinicians regarding documentation of services and appropriate coding of level of service, diagnoses, and procedures; including tips and techniques to help clinicians work more efficiently in KP Health Connect.
- Responds to or clarifies internal requests for coding information from clinicians, business, and operational partners.
- Collaborates with the KP Health Connect team and DMI physician partners to develop and implement strategies to make appropriate documentation and coding more efficient for clinicians.
- Reviews and verifies information (such as POS, attending clinician) to make sure the transaction of medical data is complete and accurate.
- Participates in development of organizational procedures and updates of forms and manuals.
- Cross collaboration with Revenue cycle, DMI, Compliance, KPHC and other operational leaders to ensure data, documentation and coding meet regulatory guidelines
- Associate of Science Degree in Health Information Technology or equivalent education or years of experience directly related to the duties and responsibilities.
Minimum Work Experience
- Minimum two (2) years progressive and in-depth multispecialty professional services coding experience in assignment of diagnostic and procedural coding or have completed the Documentation and Coding Consultant Apprentice training in the department.
- Pass internal coding test with 85% accuracy
- Ability to conduct coding reviews and quality performance measures; prepare chart review reports with recommendations; and provide education and feedback to facilitate improvement of documentation and coding.
- Ability to evaluate, analyze, compute, and summarize mathematical statistics related to medical record reviews performed with ability to prepare materials to present findings, trends, outcomes.
- Ability to conduct coding reviews to evaluate quality performance measures and using the findings create written reports with recommendations; and then present education and feedback to facilitate improvement of documentation and coding.
- General understanding of medical terminology, pharmacology, body systems/anatomy, physiology, and concepts of disease processes.
- In-depth knowledge of ICD-10-CM, CPT and HCPCS and Evaluation and Management coding guidelines.
- Exemplary attention to detail and completeness with a thorough understanding of government rules and regulations and areas of scrutiny for potential areas of risk for fraud and abuse regarding coding and documentation.
- Extensive computer experience and ability to learn new computer applications quickly and independently, including: EMR(s), Microsoft Office Suite and other software programs.
- Ability to manage a significant workload and to work efficiently under pressure meeting established deadlines with limited supervision.
- Communicates in a clear and understandable manner; exercises independent judgment; influences and coordinate the efforts of others over whom one has no direct authority.
- Attends workshops to keep abreast of current trends and changes in the laws and regulations governing medical record coding and documentation to minimize the risk of fraud and abuse and to optimize revenue recovery.
- Abides by the Standards of Ethical Coding as set forth by AHIMA and AAPC.
- Meets department standards for performance and quality - Maintains a 96% accuracy rate; failure to do so would cause a drop-in job level.
- Ability to effectively deliver virtual training model with utilization of available meeting tools such as Teams, Zoom applications.
- Must be able to articulate and understand differences in clinician teaching methodology vs. coder teaching methodology.
- Willingness to work evenings or weekends to meet client goals.
Required Licensure, Certification, Registration (LCR)
- Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist Professional (CCS-P) from AHIMA or Certified Professional Coder (CPC) from AAPC
- Bachelors degree in Health Information Management or equivalent education and experience
Preferred Work Experience and Qualifications
- Minimum five (5) years’ extensive coding experience with demonstrated ability to provide effective statistical analysis and analytical problem solving.
- Minimum two (2) years of multispecialty professional services coding experience using ICD-10, CPT and HCPCS, Evaluation and Management coding, including Medicare.
- Minimum two (2) years’ experience with project management functions and presenting education and training feedback to small and large groups.
- Comprehensive knowledge and proficiency in ICD-10, CPT and HCPCS codin
- Advanced proficiency in use of Microsoft Office Suite of products and other software programs to document and manage audit data.
At Northwest Permanente, P.C., we are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants without regard to race, color, religion, sex, pregnancy (including childbirth, lactation and related medical conditions), national origin, age, physical and mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military and veteran status, and any other characteristic protected by applicable law. Northwest Permanente, P.C. believes that diversity, inclusion, and equity among our employees is critical to our success and we seek to recruit, develop and retain the most talented people from a diverse candidate pool.