Kaiser Permanente Data Quality Auditor - Coding in Oakland, California
Under minimal supervision, ensures accurate and appropriate documentation through local coaching and monitoring. Provides documentation coaching to clinicians in the Outpatient Clinic and Emergency Department. Monitors success of coaching and training efforts through encounter audits which ensure documentation meets requirements for diagnosis and E&M assignment, based on Official ICD-9-CM Documentation Guidelines.
Using independent judgment and sensitivity, coaches individual physicians, reviewing their audit findings, making suggestions for documentation improvements and updating on changes to Federal and State government billing and coding guidelines.
Partners with Trainer in the development of future training that will address documentation risk areas identified through local and regional audits.
Plans, schedules and performs encounter audits to monitor performance and ensure lasting improvement.
Encounter audits will be the primary monitoring tool used to identify operational and regulatory issues related to coding, documentation, and compliance requirements and to ensure complete and accurate data capture in compliance with Federal and State requirements.
Monitors corrective actions for audit review findings.
Serves as a local resource in meeting internal and external regulatory requirements (e.g., Centers for Medicare & Medicaid Service (CMS), National Committee for Quality Assurance (NCQA)).
Actively participates with local CMS (Center for Medicare/Medical Services) team to ensure local objectives are met and regional CMS compliance activities are supported.
Works with medical center leadership to provide confidential audits and feedback on an as needed basis.
Assists in the identification of operational processes that hinder encounter data capture.
Enters encounter audit results into regional audit database to support quality assurance process, regional analysis and regional training activities.
Prepares and/or performs medical center auditing analysis and/or special projects as assigned.
Partners with Data Quality Trainer and other local analytical workgroups to identify audit trends and risk areas based on audit findings and data analysis.
Assists in developing and implementing policies and procedures / Compliance Audit Standards to ensure compliance with Federal, State and other regulatory requirements.
NOTE: Travel between Medical Center facilities may be required.
- Minimum three (3) years of experience coding based on Coding Clinical Guidelines for inpatient and outpatient. Project management experience including design and implementation of audit plans.
Bachelor's degree in business administration, health care, public health, finance, business medical records technology OR four (4) years of experience in a directly related field.
High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- Certification in one of the following: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Professional Coder (CPC).
Experience conducting Medical Record audits.
Project management experience including design and implementation of audit plans.
Ability to interpret and apply Federal and State regulations, coding and billing requirements.
Demonstrated ability to constructively and sensitively provide feedback to providers and medical center leadership regarding federal and state coding, medical documentation and compliance guidelines, audit results and risk areas.
Ability to work with and maintain confidentiality of physician, patient, patient account and personnel data.
Strong interpersonal and excellent written, verbal and presentation skills.
Demonstrated ability to work independently with minimal supervision.
Demonstrated ability to work within a team environment.
Willingness to be flexible depending upon department and/or physician schedule needs.
Demonstrated ability to review analytical data and audit findings to identify documentation trends and other risk areas.
Demonstrated ability to develop data requirements and work with analytical groups to extract, organize and analyze coded data.
Must be able to work in a Labor/Management Partnership environment.
Experience using PC applications such as MS Word, Excel, Access, PowerPoint.
Medical center operations or clinical experience.
TITLE: Data Quality Auditor - Coding
LOCATION: Oakland, California
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.