Ensure that coding and documentation for assigned areas meet Kaiser Foundation Health Plan of Washington compliance and quality standards. Serve as a coding resource to staff throughout Kaiser Foundation Health Plan of Washington. Perform needs assessment and implement coding education for practitioners, ancillary staff, Business Operations and CIS staff. Research complex coding issues and maintain a knowledge base regarding policies and guidelines from CMS and other payers. Teach complex coding issues and concepts. Evaluate medical record documentation against coding and billing compliance standards and provide detailed reports of findings. Develop and implement coding improvement plans. Consult with providers and business office staff to advise on coding issues. Serve as a committee member or project manager for coding issues.
Conducts performance analysis and needs assessment of complex coding, documentation and compliance issues. Develops, implements and evaluates coding education. Conducts specialized education and classroom training for providers, clinical support staff, and business staff in documentation, billing, compliance and selection of CPT and ICD-9 CM codes. Educates, serves as a resources for and assists with monitoring Coding Review Unit staff in Patient Financial Services. Develops specialty specific education materials for classroom and individual practitioner training as well as Epic job aids. Communicates complex coding issues to various audiences throughout KFHPW.
Serves as the coding, documentation, reimbursement and compliance expert consultant to designated specialty and primary care teams. Demonstrates resource expertise on compliant coding and billing, and regulatory requirements. Researches clinical specialties, coding changes and guidelines, Federal and State health care billing rules and regulatory requirements, and industry-standard billing practices. Based on audit findings, may lead project work, start to finish, around corrective compliance actions, reporting directly to the Compliance Officer and legal counsel. Researches and responds to formal coding and billing appeals.
Performs medical record documentation audits of patient care against services and diagnoses reported by providers, following the KFHPW Coding and Billing Quality Plan. Develops audit schedules and monitors audit progress to ensure timelines are met. Reports formal audit findings to Medical Staff and Operations leaders. Develops and implements improvement plan based on audit findings.
Designs and maintains medical record forms and charge capture documents. Reviews Epic system set-ups to assure that master files and tools are compliant with coding and billing rules. Makes recommendations to CIS team on changes and enhancements to the Epic system.Acts as a project manager, displaying effective teamwork and leadership skills, setting and meeting deadlines and objectives for projects assigned; leads and participates in committees as requested; effectively collaborates with CBO, Business Operations, CIS and the delivery system.
Provides extensive support to the delivery system and business office staff, before, during and after Epic implementation. Identifies coding errors and process issues, provides feedback. Assesses needs and provides appropriate training prior to go-live, provides on-site support during go-live and maintains support and assistance once implementation phase is completed. Assures compliance, assesses and provides appropriate education with respect to accurate and compliant coding in Epic. Evaluates medical record documentation in the electronic record against coding and billing standards and provides detailed reports of findings. Develops processes to assist providers in maximizing Epic efficiencies while maintaining correct coding and compliance.
Minimum five (5) years of progressively responsible experience in ICD-9-CM, CPT and HCPCS coding in a clinic setting, to include chart auditing experience.
Bachelor's degree in a health care or education related field OR a minimum five (5) years of experience in a directly related field.
High School Diploma OR General Education Development (GED) required.
License, Certification, Registration
Able to obtain shortly after hire: CPC, CCS-P, RHIT, RHIA, CCS, CPC-H certificate or eligibility.
Experience in application of compliant coding principles, including Medicare compliance issues.
Extensive knowledge of health care billing and reimbursement including industry standard billing rules, Medicare, Medicaid, L&I and commercial insurance.
Knowledge of adult learning theory and instructional approaches.
Knowledge of medical terminology and medical science and disease processes, anatomy and physiology.
Progressively responsible roles in clinical coding, business and training.
In-depth knowledge of ICD-9, CPT and HCPCS coding and documentation.
Communication, presentation, interpersonal and customer service skills.
Conflict resolution and problem solving skills.
Demonstrated ability to implement up to date and compliant coding information in a complex clinical setting.
Computer proficiency in a Windows environment, including MS Word, PowerPoint and Excel.
Seven (7) years of Progressively responsible experience in ICD-9-CM, CPT and HCPCS coding in a multi-specialty practice, hospital professional and hospital facility settings, including chart auditing experience.
Hospital and clinic experience.
Bachelor's degree AND additional related work experience preferred.
At time of hire CPC or CCS-P.
Extensive knowledge of Medicare compliance issues and health care coding, billing and reimbursement in a fee-for-service environment.
Knowledge of APCs and DRGs.
EpicCare and Last Word knowledge.