Compliance Consultant III, Medical Coding Information Technology
Company: Kaiser Permanente
Posted on: March 10, 2023
With a focus on promoting honesty and reliability in all our
daily actions, you'll ensure that we uphold the highest standards
throughout our system.Compliance Consultant III, Medical Coding
Information Technology Primary Location Aurora, Colorado Job Number
1136036 Date posted 02/28/2023 Performs audits of medical
documentation, claims and other operational materials with the goal
of ensuring accurate submissions to CMS and to support Kaiser
Permanente receiving appropriate reimbursement in accordance with
Medicare Advantage requirements. Contributes expertise to the
development of clinician training on Medicare's Risk Adjustment/HCC
Model. Maintains and supports a culture of compliance, ethics, and
integrity. Maintains knowledge of policies and procedures and
performs in accordance with applicable regulatory requirements,
external laws, and accreditation standards as they relate to Coding
and medical billing. This position is responsible for consistently
maintaining high quality results towards organizational goals and
objectives pertinent to provider coding, billing, and documentation
- Conducts audits of provider and facility documentation and
coding in medical records of Medicare Advantage members.
- Participates and supports the un-refreshed HCC and RxHCC
diagnosis capture process, including the Medicare physician query
- Reviews data, determines issues and specific or systemic
- Provides general comments related to audit findings and makes
recommendations for follow up actions to correct weaknesses
identified through the audit process.
- Maintains a sustained level of 95% coding accuracy and
productivity to support auditing and feedback schedules and comply
with department standards.
- Contributes to the development and maintenance of Medicare
Advantage specific education materials for clinicians.
- Supports the Medicare Risk Business Services team, including
the CPMG Physician lead.
- Provides support to clinicians on coding and documentation
questions related to Medicare Advantage.
- Maintains current knowledge of coding conventions, changes, and
regulations governing Medicare Advantage billing to ensure that
Kaiser Permanente Colorado coding and documentation meets
regulatory guidelines and audit standards, and results in
- Provides support to the Medicare Risk Business Services team,
including the CPMG physician lead.
- Performs other duties as assigned. Minimum Qualifications:
- High School Diploma OR General Education Diploma (GED)
- Minimum of four (4) years of experience in outpatient or
inpatient professional coding using ICD-10, CPT-4, and HCPCS in
medical billing and third-party payer regulations.
- Minimum of one (1) year of experience in auditing medical
record documentation required. Preferred Qualifications:
- Reimbursement experience with Medicare Part C and/or
third-party liability billing required.
- Successful completion of internal assessment test
- Minimum of six (6) months of sustained 95% accuracy in current
position for internal employees in the coding department.
- Demonstrated ability to interact in a collaborative manner
within a team environment.
- Demonstrated ability to understand the clinical content of a
health record including the most complicated records.
- Demonstrated ability and experience in preparing chart note
audits, medical documentation training and in development of
instructional materials for training.
- Excellent written, communication, and presentation skills with
the ability to explain, and write complex information in a clear,
concise, and organized format.
- Ability to communicate with physicians and non-physician staff
with a commitment to provide quality customer service.
- Demonstrated expert level of knowledge of anatomy and
physiology, medical terminology, disease process, reimbursement
methodologies, and conventions, rules, guidelines for current
- Ability to analyze audit findings to identify root cause and
provide recommendations for improvement of workflow and business
- Excellent time and organizational skills.
- Prefer working knowledge of outpatient/inpatient physician
service delivery and of the electronic medical record system.
- Must maintain all certifications required by the position.
- Must meet and maintain departmental quality and production
- Expert knowledge of ICD-10-CM, CPT, and HCPCS classification
- Familiarity with DRG. APC, and other reimbursement
- Professional Coder Certificate from American Academy of
Professional Coders OR Certified Coding Specialist from American
Health Information Management Association Primary Location:
Colorado,Aurora,Waterpark I Scheduled Weekly Hours: 40 Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 08:00 AM
Working Hours End: 05:00 PM Job Schedule: Full-time Job Type:
Standard Employee Status: Regular Employee Group/Union Affiliation:
NUE-PO-01-NUE-Non Union Employee Job Level: Individual Contributor
Specialty: Compliance General Department: Po/Ho Corp - Rev Cycle
Exec Operations Core - 0308 Pay Range: $76900 - $99550 Travel: No
At Kaiser Permanente, equity, inclusion and diversity are
inextricably linked to our mission, and we aim to make it a part of
everything we do. We know that having a diverse and inclusive
workforce makes Kaiser Permanente a better place to receive health
care, a more supportive partner in our communities we serve, and a
more fulfilling place to work. Working at Kaiser Permanente means
that you agree to and abide by our commitment to equity and our
expectation that we all work together to create an inclusive work
environment focused on a sense of belonging and wellbeing.
Kaiser Permanente is an equal opportunity employer committed to a
diverse and inclusive workforce. Applicants will receive
consideration for employment without regard to race, color,
religion, sex (including pregnancy), age, sexual orientation,
national origin, marital status, parental status, ancestry,
disability, gender identity, veteran status, genetic information,
other distinguishing characteristics of diversity and inclusion, or
any other protected status.
Keywords: Kaiser Permanente, Aurora , Compliance Consultant III, Medical Coding Information Technology, Healthcare , Aurora, Colorado
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