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Compliance Consultant III, Medical Coding Information Technology

Company: Kaiser Permanente
Location: Aurora
Posted on: March 10, 2023

Job Description:

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 requirements.

  • 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 process.
  • Reviews data, determines issues and specific or systemic causes.
  • 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 appropriate reimbursement.
  • 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) required.
    • 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 required.
      • 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 coding classification.
      • Ability to analyze audit findings to identify root cause and provide recommendations for improvement of workflow and business practices.
      • 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 standards.
      • Expert knowledge of ICD-10-CM, CPT, and HCPCS classification systems.
      • Familiarity with DRG. APC, and other reimbursement methodologies.
      • 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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