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.
Develop coding and presentation skills to provide training, consultation, audit and feedback to clinicians on their medical service documentation and coding to ensure that KPNW receives appropriate reimbursement and conforms to applicable guidelines and regulations.
- Research Coding guidelines and develop skills to Provide expert consultation to specialists or primary care clinicians as assigned on coding and documentation questions.
- Within assigned clinical specialties, maintain current knowledge to ensure that KPNW coding and documentation meets regulatory guidelines and audit standards utilizing the support of a Coding Educator or Coding Lead.
- Sequences all codes appropriately using coding rules and guidelines.
- Researches new diagnostic and procedure codes utilizing CPT4, ICD-10 and HCPCS codes and assigns codes as appropriate.
- Reviews and verifies component parts of the medical records to ensure the accuracy of diagnostic and therapeutics procedures is complete and conforms to CMS coding rules and guidelines under the direction of the Coding Educator or Coding Lead.
- Provide support to Coding Educator to present 20 minutes of material within a lunchtime team meeting; as well as up to 4 hours of medical specialty specific training or as part of the New Hire Clinician training team.
- Carefully analyzes and chooses educational presentation training points to emphasize; to ensure training is relevant and meets provider needs appropriately to improve or maintain, consistent and accurate provider code selection under the direction of the Coding Educator or Coding Lead
- Utilizes appropriate department resources and processes (i.e. discussions with team members) when code assignment is not straightforward or documentation is inadequate, ambiguous or unclear for coding purposes.
- Under the direction of a Coding Lead, Performs periodic quality audits of documentation and coding in EpicCare.
- Reviews and verifies information (such as POS, attending provider) to make sure the transaction of medical data is complete and accurate, under the direction of a Coding Lead or Coding Educator
- Analyzes audit results and provides summary feedback under the direction of a Coding Lead, to individual clinicians, making recommendations for improvement by providing coding education.
- Creates and maintains tools to audit professional coding service data.
- Applies consistent coding practice standards when conducting chart audits, using good judgment in preparing individualized recommendations for improvement under the direction of a Coding Lead or Coding Educator.
- Uses overall audit data results to develop topics for future department training opportunities for physician and coders, under the direction of a Coding Lead or Coding Educator.
- Shadow and develop skillset to provide on-site 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.
- Contributes to the development and maintenance of specialty-specific coding education materials under supervision of Coding Educator or Coding Lead
- Responds to or clarifies internal requests for coding information under supervision of the Coding Educator or Coding Lead.
- Develop system skillset to Collaborate with the KP Health Connect team and provide recommendations to develop and implement strategies to make appropriate documentation and coding more efficient for clinicians, under the direction of a Coding Lead or Coding Educator.
- Participates in development of organizational procedures and updates of forms and manuals.
- Willingness to work evenings or weekends to meet client goals.
- Perform other duties as requested.
- Demonstrates strong analytical and organizational skills related to complex code assignment.
- Ability to analyze audit results, identify patterns, trends or variations in coding and documentation practices and make recommendations for improvement.
- Exercises independent thought and judgment and respond quickly and knowledgeably to questions regarding specific coding and documentation requirements.
- Demonstrates strong time management skills with exemplary attention to detail and completeness.
- Sets priorities in a manner that best provides value to the organization.
- Ability to initiate and maintain confidentiality and effective working relationships with coding staff while evaluating their work.
- Demonstrates interpersonal intuition, sensitivity and respect in developing and maintaining positive relations with internal and external customers.
- Exhibits the ability to tactfully communicate organizational deficiencies and create suggestions for process improvement.
- Comprehends the rational for and creatively implements department standards for performance and quality.
- Comprehends the impact of Medicare and other Risk adjusted programs, as well as HCC issues regarding KPNW accounting procedures and needs.
Human Relations Skills
- Ability to communicate verbally and in writing, using reference sites to clarify diagnostic/procedural information in the medical record, that supports proper documentation according to coding and governing agency guidelines.
- Ability to maintain effective working relationships with others, exhibiting a positive and cooperative outlook towards his/her position, the organization and fellow employees.
- Ability to be courteous, tactful, and cooperative through personal interactions to answer questions about appropriate coding and documentation.
- Customer service abilities including effective listening skills.
- Communicates verbally with peers to ensure consistency in the assignment of codes and to enhance team spirit.
- Communicates with staff of other departments to resolve work-related issues.
- Must maintain professional credibility and confidentiality
- Heavy use of a computer on a daily basis; photocopy and facsimile machines.
- Job requires driving to various KPNW sites and occasional evening meeting.
- Exposure to routine office products and hazards from electrical/mechanical/power equipment.
- Uses computer equipment extensively. Visual acuity of 20/60 in at least one eye (with/without corrections); hearing sensitivity bilateral within normal limits aided/non-aided or speech discrimination within functional limits for telephone and personal communication.
- Moderate physical effort; lift/carry up to 30 pounds occasionally during workday. Ability to lift supplies/equipment occasionally. Occasional bending, stooping, pushing, pulling, kneeling, crouching, reaching, overhead lifting. Frequent sitting, grasping and repetitive motion.
- Demonstrates a willingness to flex routine work hours; and if possible, may choose to work some weekend and/or evening hours to help meet changing client KPNW goals
- Ability to evaluate, analyze, compute, and summarize mathematical statistics related to medical record audits performed with ability to prepare materials to present findings, trends, outcomes under supervision of Coding Educator or Coding Lead.
- Ability to learn and comprehend importance of conducting coding audits to evaluate quality performance measures and using the findings create written reports with recommendations; and then develop skills to present education and feedback to facilitate improvement of documentation and coding.
- Gain Understanding of medical terminology, pharmacology, body systems/anatomy, physiology and concepts of disease processes during training and enrolled course work.
- Gain Understanding of ICD-10, CPT and HCPCS and Evaluation and Management coding guidelines under supervision and guidance of Coding Educator or Coding Lead.
- 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 in regards to coding and documentation.
- 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 work-load and to work efficiently under pressure meeting established deadlines under supervision of Coding Educator or Coding Lead.
- 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 an acceptable level of accuracy rate based on monthly results.
Minimum Education & Experience
- High school diploma or equivalent
- Currently enrolled in or completed college course work for coding and/or communication course or equivalent work experience in Healthcare field
Required license, registration, certification or professional affiliation
- Must complete and attain certification within 12 months of hire date. Preferred and acceptable certification/licenses are CPC, CCS-P, RHIT.
- Minimum of 2 years extensive auditing experience with demonstrated ability to provide effective statistical analysis and analytical problem solving.
- Minimum of 1 year experience in multispecialty professional services coding using ICD-10, CPT and HCPCS, Evaluation and Management coding, including Medicare.
- Minimum of 1 year experience with project management functions and presenting education and training feedback to small and large groups
- Bachelor Degree in Health Information Management or equivalent education or years of experience directly related to the duties and responsibilities.
- Comprehensive knowledge and proficiency in ICD-10, CPT and HCPCS coding.
- 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.