Kaiser Permanente
Coding Compliance Auditor - Maui Health
Kaiser Permanente, Wailuku, Hawaii, United States, 96793
Overview
HIM Coding auditor/trainer will coordinate, monitor, and audit documentation and coding of inpatient and/or outpatient services in all applicable health care settings. Audits will focus on correct assignment of CPT, ICD-10, ICD-9-CM, HCPCS codes and clinician documentation to ensure compliance with regulatory guidelines and internal controls. Audits will encompass internal practitioners, contracted practitioners, coders, internal facilities and contracted facilities. The auditor will analyze audit results, identify patterns, trends or variations in coding and documentation practices and make recommendations for improvement. When necessary, this position will initiate corrective action plans to resolve problem areas identified during auditing and monitoring activity. This position will serve as a liaison with HIM staff, Revenue Cycle, External and Internal practitioners, and other regional departments including, but not limited to, IT and benefits.
Essential Responsibilities
Reviews and audits coders based on federal regulatory requirements (e.g., CMS) and current documentation and coding guidelines, ensuring compliance with departmental/internal policies and other applicable laws and regulations.
Prepare written audit reports for noted deficiencies and make recommendations to Coding and Revenue Cycle Compliance Manager, HIM director, and others as appropriate (e.g., training, oversight, monitoring, process flows). Conduct trend analyses to identify patterns and variations in coding practices and case-mix index.
Develop and deliver education and training programs related to results of document and coding reviews, and findings from RAC and other regulatory audits.
Compare coding and reimbursement profile with regional and national norms. Review coding claim denials and rejections.
Receive and investigate reports of compliance violations. Communicate results to HIM director and compliance officer. Ensure dissemination and communication of all regulation, policy, and guideline changes to affected personnel.
Experience
Basic Qualifications : Minimum four (4) years inpatient coding experience in an acute care setting, including experience with ICD-10, ICD-9-CM, CPT4 and HCPCS coding systems, UHDDS definitions, and other related documentation requirements.
Education
Bachelor’s degree in healthcare, health information management or related field OR four (4) years of directly related experience.
License, Certification, Registration
Certified Coding Specialist (AHIMA) OR Registered Health Information Administrator (AHIMA) OR Certified Professional Coder (AAPC) OR Registered Health Information Technician (AHIMA).
Additional Requirements
Must possess a proficient understanding of the Inpatient and Outpatient Prospective Payment Systems (IPPS/OPPS), Medical Severity Diagnosis-Related Groups (MS-DRG), and National Correct Coding Initiative Edits (NCCI), ICD-10-CM Official Guidelines for Coding and Reporting and Coding Clinic.
Working knowledge of relevant federal and state regulations, Medicare guidelines, and compliance issues.
Advanced understanding of medical terminology, pharmacology, anatomy and physiology, and disease processes. Demonstrated knowledge of data collection, statistical analysis, and interpretation.
Strong oral and written communication, problem solving, analysis, project management, quality management, systems thinking, and customer service skills.
Proficiency with word processing, spreadsheet, and database applications.
Ability to make decisions, influence, lead, and collaborate in a team environment and manage change.
Preferred Qualifications
Completion of an accredited Health Information Management program.
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Finance and Sales
Industries
Hospitals and Health Care
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HIM Coding auditor/trainer will coordinate, monitor, and audit documentation and coding of inpatient and/or outpatient services in all applicable health care settings. Audits will focus on correct assignment of CPT, ICD-10, ICD-9-CM, HCPCS codes and clinician documentation to ensure compliance with regulatory guidelines and internal controls. Audits will encompass internal practitioners, contracted practitioners, coders, internal facilities and contracted facilities. The auditor will analyze audit results, identify patterns, trends or variations in coding and documentation practices and make recommendations for improvement. When necessary, this position will initiate corrective action plans to resolve problem areas identified during auditing and monitoring activity. This position will serve as a liaison with HIM staff, Revenue Cycle, External and Internal practitioners, and other regional departments including, but not limited to, IT and benefits.
Essential Responsibilities
Reviews and audits coders based on federal regulatory requirements (e.g., CMS) and current documentation and coding guidelines, ensuring compliance with departmental/internal policies and other applicable laws and regulations.
Prepare written audit reports for noted deficiencies and make recommendations to Coding and Revenue Cycle Compliance Manager, HIM director, and others as appropriate (e.g., training, oversight, monitoring, process flows). Conduct trend analyses to identify patterns and variations in coding practices and case-mix index.
Develop and deliver education and training programs related to results of document and coding reviews, and findings from RAC and other regulatory audits.
Compare coding and reimbursement profile with regional and national norms. Review coding claim denials and rejections.
Receive and investigate reports of compliance violations. Communicate results to HIM director and compliance officer. Ensure dissemination and communication of all regulation, policy, and guideline changes to affected personnel.
Experience
Basic Qualifications : Minimum four (4) years inpatient coding experience in an acute care setting, including experience with ICD-10, ICD-9-CM, CPT4 and HCPCS coding systems, UHDDS definitions, and other related documentation requirements.
Education
Bachelor’s degree in healthcare, health information management or related field OR four (4) years of directly related experience.
License, Certification, Registration
Certified Coding Specialist (AHIMA) OR Registered Health Information Administrator (AHIMA) OR Certified Professional Coder (AAPC) OR Registered Health Information Technician (AHIMA).
Additional Requirements
Must possess a proficient understanding of the Inpatient and Outpatient Prospective Payment Systems (IPPS/OPPS), Medical Severity Diagnosis-Related Groups (MS-DRG), and National Correct Coding Initiative Edits (NCCI), ICD-10-CM Official Guidelines for Coding and Reporting and Coding Clinic.
Working knowledge of relevant federal and state regulations, Medicare guidelines, and compliance issues.
Advanced understanding of medical terminology, pharmacology, anatomy and physiology, and disease processes. Demonstrated knowledge of data collection, statistical analysis, and interpretation.
Strong oral and written communication, problem solving, analysis, project management, quality management, systems thinking, and customer service skills.
Proficiency with word processing, spreadsheet, and database applications.
Ability to make decisions, influence, lead, and collaborate in a team environment and manage change.
Preferred Qualifications
Completion of an accredited Health Information Management program.
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Finance and Sales
Industries
Hospitals and Health Care
We’re keeping the application process straightforward. Get notified about new Compliance Auditor jobs in Wailuku, HI.
#J-18808-Ljbffr