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.
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.
Major Responsibilities / Essential Functions
- Provides 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.
- Sequences all codes appropriately using coding rules and guidelines.
- Researches new diagnostic and procedure codes utilizing CPT4, ICD9/CM-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.
- Ability 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.
- Utilizes appropriate department resources and processes (i.e. discussions with team members) when code assignment is not straight forward or documentation is inadequate, ambiguous or unclear for coding purposes.
- Performs periodic quality audits of documentation and coding in EpicCare.
- Analyzes audit results and provides summary feedback 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.
- Uses overall audit data results to develop topics for future department training opportunities.
- Provides 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.
- Responds to or clarifies internal requests for coding information.
- Collaborates with the KP Health Connect team to develop and implement strategies to make appropriate documentation and coding more efficient for clinicians.
- Reviews and verifies information (such as POS, attending provider) to make sure the transaction of medical data is complete and accurate.
- 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.
- 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
- 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 Educator apprentice training in the department.
- Ability to conduct coding audits and quality performance measures; prepare audit 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 audits performed with ability to prepare materials to present findings, trends, outcomes.
- Ability to conduct coding audits 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.
- Advanced understanding of medical terminology, pharmacology, body systems/anatomy, physiology and concepts of disease processes.
- In-depth knowledge of ICD-9/10-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 in regards to 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 work-load 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.
- Final candidate will be required to pass internal Coding test with 85% accuracy or better.
Required Licensure, Certification, Registration (LCR)
- Required license, registration, certification or professional affiliation: 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 or years of experience directly related to the duties and responsibilities.
Preferred Work Experience and Qualifications
- Five (5)+ years extensive auditing experience with demonstrated ability to provide effective statistical analysis and analytical problem solving.
- Two (2)+ years of multispecialty professional services coding experience using ICD9/CM-10, CPT and HCPCS, Evaluation and Management coding, including Medicare.
- Two (2)+ years experience with project management functions and presenting education and training feedback to small and large groups.
- Comprehensive knowledge and proficiency in ICD9/CM-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.