Job Details: Coding QA Auditor

Company: Kaiser Permanente - Colorado – Today, we are the largest nonprofit health care organization in the United States, serving approximately 8.2 million people in nine states and the District of Columbia.

Description: If you are a Colorado Internal Employee, you must place your bid on the bid line 303-614-1510, not online.
Job Summary: Performs clinical coding audits, provides coding analysis and assistance, and prepares feedback for audited staff to ensure that Kaiser Permanente Colorado receives appropriate reimbursement and conforms to applicable guidelines and regulations. Maintains and supports a culture of compliance, ethics and integrity. Responsible for ensuring ongoing compliance for the Coding Department. Maintains knowledge of policies and procedures and performs in accordance with applicable regulatory requirements, external laws and accreditation standards as they relate to Coding.

Job requirements: Three years of outpatient or inpatient professional coding experience using ICD-9, CPT-4, and HCPCS to include one year of performing coding audits and providing feedback to facilitate improvement of coding based on audit results. AHIMA or AAPC coding certification (CCS, CCS-P, CCS-H, CPC or equivalent credentialing required. Must pass internal proficiency assessment exam. Demonstrates ability to understand the clinical content of a health record including the most complicated records. Must possess a thorough knowledge of coding conventions, governmental regulations, and third party billing requirements. Demonstrates ability to apply analytical skills in the evaluation of medical records and develop education enhancements for noted deficiencies. Excellent and demonstrated written and oral communication skills with the ability to explain complex information in a clear, concise, and organized format. Must be able to communicate with healthcare professionals at all levels. Working knowledge of medical specialties, including clinical conditions seen and procedures performed. Demonstrates ability to use spreadsheet and word processing applications. Working knowledge of electronic medical record systems preferred. Must maintain all certifications required by this position.

Essential Responsibilities: Audits the accuracy and consistency of provider and/or assigned coding for level of service (CPT-4), diagnosis (ICD-9CM), and procedures (CPT-4 and HCPCS) of Kaiser Permanente Commercial encounters, by conducting internal coding audits from the current electronic medical record used by Kaiser Permanente Colorado. Analyzes and trends audit results and provides oral and written feedback to Coding Education and Coding Management, making recommendations for improvement. Collaborates with Coding Education and Coding Management, to develop, implement and communicate specific coding and documentation guidelines that will fulfill the internal needs for complete and consistent clinical data. Interprets national and state coding and documentation guidelines for coders in order to ensure consistent and accurate implementation and compliance with external regulators. Maintains current knowledge of assigned specialty area to ensure that Kaiser Permanente Colorado coding and documentation meets regulatory guidelines and audit standards, and results in appropriate reimbursement. Contributes to the maintenance of tools to audit service data. Performs other duties as assigned. Supports compliance and Kaiser Permanente's Code of Conduct by adhering to federal and state laws and regulations, accreditation and license requirements, by policies and procedures. Responds appropriately to observed fraud and abuse.

Functional and environmental factors available upon request

Schedule: Variable hours Mon- Fri.

Starting Salary Range: $3980 - $5074 (Monthly)

Posting Date: May 14 08