Kaiser Permanente Clinical Data Integrity Consultant- Quality Assurance and Research in Oakland, California

This position uses knowledge of clinical, coding, and healthcare regulations for documentation requirements to ensure the audit staff facilitate and are compliant in obtaining appropriate provider documentation with the legal medical records to improve patient quality and compliant CMS submission. Educates staff in understanding the clinical documentation requirements for diagnosis capture. Has expertise in understanding the clinical documentation required for completeness and integrity of the patient's records using a multidisciplinary team process.

Essential Functions:

  • Serves as expert recourse to facilitate and monitor audit staff to ensure appropriate clinical documentation is captured to support diagnosis and to ensure the level of service rendered to all patients is accurately reflected in the record.

  • Reviews auditor work to ensure audit objectives are met and documentation is compliant.

  • Monitors, educates, provides feedback, and reports compliance to ensure an effective finding/process as mandated by Compliance and regulatory requirements.

  • Makes recommendations to audit managers and provide additional education/training to assigned regional and local staff.

  • Develops and presents educational sessions to audit staff regarding clinical documentation requirements needed for diagnosis capture, in alignment with regulatory standards and coding guidelines.

  • Exercises discretion in ability to make decisions that may impact the program.

  • Provides expert advice to facility and regional Audit Managers to develop, implement and monitor procedures that support organizational goals and business objectives related to the Revenue Cycle/EIO Audit Programs.

  • Collaborates in the development of programs which provide alignment with education for internal customers to support clinical documentation guidelines.

  • Leads special projects that contribute to the development of an effective CDI program. Works with Regional Coding Review Managers to develop, implement and monitor departmental policies and procedures that support organizational goals, business objectives, regulatory needs and requirements.

  • Kaiser Permanente conducts compensation reviews of positions on a routine basis. At any time, Kaiser Permanente reserves the right to reevaluate and change job descriptions, or to change such positions from salaried to hourly pay status. Such changes are generally implemented only after notice is given to affected employees.

Basic Qualifications:

Experience

  • Minimum six (6) years of inpatient/outpatient coding experience.

Education

  • Graduate from an accredited Health Information Management Program.

  • Associate's (or higher) degree OR two (2) years of experience in a directly related field

  • High School Diploma or General Education Development (GED) required.

License, Certification, Registration

  • Certified Physician Coder (CPC) or Certified Coding Specialist (CCS/CCS- P).

Additional Requirements:

  • Seasoned coder with clinical knowledge.

  • Strong interpersonal communication (verbal, non-verbal listening skills).

  • Understand Adult Learning Theory with demonstrated ability to develop and present educational sessions.

  • Understand coding classification systems such as ICD-9 CM, CPT, and HCPCS, MS-DRGs.

  • Working knowledge of HCCs.

  • Demonstrated ability to conduct and interpret quantitative/qualitative analysis.

  • Proven leadership skills in project management and consulting. Must exhibit efficiency, collaboration, candor, openness, and results orientation.

  • Demonstrates an understanding of the operations and/or business of KP, health policy trends and any applicable regulatory requirements related to the responsible practice area.

  • Must be able to work in a Labor/Management Partnership environment.

Preferred Qualifications:

  • Strong knowledge and understanding of patho-physiology, disease process and clinical documentation preferred.

COMPANY: KAISER

TITLE: Clinical Data Integrity Consultant- Quality Assurance and Research

LOCATION: Oakland, California

REQNUMBER: 679840

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.