Description: Manages all activities related to physician/provider coding education for outpatient and inpatient professional fee services. Develops and maintains a close working relationship with Medical Group and Operations management to support provider coding accuracy that is consistent with industry standards and in compliance with coding guidelines. Works in conjunctions with provider education to improve coding accuracy and efficiency. Accountable for developing/maintaining a culture of service, financial discipline, compliance, ethics and integrity. Maintains knowledge of and assures departmental compliance with Kaiser Permanente's Principles of Responsibility, policies and procedures, applicable regulatory requirements and accreditation standards. Responds appropriately to observed fraud or abuse.
- Manages the Provider Coding Education Program, supporting a high level of coding accuracy.
- Develops provider education results reporting and communication for multiple audiences.
- Develops the Coding Education management team and staff.
- Manages the Coding Education department operational budget.
- Assesses impact of current compliance activities and evaluating risk factors in coding and documentation practices.
- Plans and forecasts the organization's future needs for Provider Coding Education.
- Uses understanding of interrelationships among systems across functional areas to redesign processes, improves efficiency and ensures optimal results for the future.
- Monitors changes in laws, regulations, and coding and documentation standards as they apply to the Coding Education Department and Providers of Kaiser Permanente Colorado.
- Participates in Committees or Workgroups as required.
- Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines.
- Supervises direct reports; including interviewing, selecting, training, motivating, evaluating, counseling, disciplining and terminating in compliance with EEO/AA goals and personnel policies of the organization.
- Minimum eight (8) years of progressively responsible experience in a coding environment, including five (5) years of supervisory/management experience.
- Experience in developing educational materials and conducting training and education sessions a multi-specialty setting is required.
- Previous experience providing expert consultation to clinicians.
- Bachelor's degree in business administration, health care administration, health information management, or related field OR four (4) years of experience in a directly related field.
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- AAPC or AHIMA Coding Certification required.
- Must be able to work in partnership with Labor and Medical Group to assure compliance with documentation and coding guidelines is achieved, resulting in the accurate representation of services provided and diagnoses reported.
- Proven analytical and organizational ability.
- Proven communication and presentation skills, demonstrated experience with provider auditing in CPT-4, ICD-9-CM, and HCPCS as well as knowledge of Medicare Part C Reimbursement (HCC Model).
- Strong written, verbal and interpersonal communication skills required. Must maintain all certifications required of this position.
- Experience with electronic medical record preferred.
- Project management experience preferred.
- RHIA or RHIT certification preferred.