Clinical & Documentation Review Consultant

Description:

Plans, coordinates, & conducts concurrent & retrospective quality reviews or audits related to coding &/or clinical documentation integrity (CDI) functions & work performance impacting billing, & data reporting. Develops & educates the coding & CDI staff, as well as physicians if necessary, in understanding the coding & clinical documentation requirements for diagnosis capture, in alignment w/regulatory standards & coding guidelines. Provides expert advice to facility & Reg-l groups to develop, implement & monitor procedures that support organizational goals & business objectives related to the Revenue Cycle, Encounter Information Operations (EIO) Audit Programs. Assures compliance w/Reg-l & Nat-l coding policies & procedures. Plans, performs or supervises audits. Develops an audit corrective action plan for improvement & monitors compliance w/the plan. Assists w/coding & CDI questions, provides guidance memos on coding & clinical documentation related issues/topics. Develops & presents coding educational in-srvs & seminars to the Reg-l coding staff, CDI staff, & others as directed & as needed.

Essential Functions:

• Monitors the accuracy & quality of coding & CDI assignments, Present on Admission (POA) indicators & conducts internal coding audits.
• Helps set the direction for coding & compliance Edu & focused projects related to the electronic medical record.
• Develops reports of audit findings as required for operational, compliance & risk reporting.
• Develops, maintains, & communicates up-to-date & accurate coding & clinical documentation guidelines & policies to all impacted parties.
• Provides Edu & training on coding & documentation issues identified during audits & reviews.
• Monitoring & Reporting: Monitors & coordinates coding & clinical documentation integrity audit activities.
• Develops & presents reports of audit results to Reg-l & facility staff & Sr Mgmt.
• Functions as a liaison for other Depts regarding coding & CDI audit questions & issues.
• Audit Coordination: Coordinates w/the coding & CDI Mgmt in planning & performing coding & documentation reviews for effective & timely completion of work.
• This job description is not all encompassing.
• Collaborates w/the coding & CDI Mgmt staff in the developing programs which provide alignment w/Edu for internal customers to enhance clinical documentation & comply w/coding guidelines.
• Quality Audits & Reviews: Coordinates monitors & audits all lines of hospital business for coding & clinical documentation integrity, to include: all outpatient, inpatient, HOV, ED & Ambulatory surgery cases.
• Collaborate w/the Revenue Cycle Business Risk Mgmt & other compliance & risk Mgmt units in identifying risk areas in coding & clinical documentation based on audit findings.
• Conducts data & root cause analysis, provides feedback & shares findings to revenue cycle leaders & others as appropriate.
• Coding & Clinical Documentation Edu & Training: Supports the Reg-l coding & clinical documentation audit, Edu, & training needs of the region.
• Acts as the Reg-l coding contact person for the HIM Dept to support Edu & coding requirements.
• Conducts exit conferences on audit findings for the coding & CDI staff & Mgmt.
• Prepares statistical & annual reports as requested by Revenue Cycle leadership, state or Fed agencies or any others.
• Run audit selection lists & reports as well as providing Edu, feedback & guidance based upon data mining activities, processes & clinical documentation requirements.
• Provide oversight & training for Coding Compliance Software to the coding staff.

Basic Qualifications:

Experience

• Minimum two (2) years of acute care, inpatient, outpatient, DRGs, HCCs and APCs auditing required.
• Minimum five (5) years of acute care, inpatient, outpatient, DRGs, HCCs and APCs coding required.

Education

• Associate's degree in health information management, business administration, health care administration, or other related field OR two (2) years of experience in a directly related field.
• High School Diploma or General Education Development (GED) required.

License, Certification, Registration

• CCS or CCS eligible, RHIA/RHIT

Additional Requirements:

• Demonstrated strong interpersonal and communication skills.
• Current knowledge of ICD and CPT coding systems.
• Knowledge of computerization and technological advances in health information.
• Must be able to work in a Labor/Management Partnership (union) environment.
• Provide high quality in-service and seminar of coding and coding related topics and clinical documentation integrity.
• Familiarity with important areas such as privacy, security and confidentiality impacting sharing of clinical information.
• Working knowledge of Hierarchical Condition Category (HCC) coding and reimbursement methodology.
• Understanding of state/federal regulations that impact coding and reimbursement.

Preferred Qualifications:

• Bachelor's degree in health information management, business administration, healthcare administration or other related field.
• CCDS credential preferred.
• AHIMA Certified ICD-10 trainer preferred.
• CDIP credential preferred.
• Minimum one (1) year of experience using electronic health records (EHR).

Primary Location: California,Oakland,1800 Harrison

Scheduled Weekly Hours: 40

Shift: Day

Workdays: Mon, Tue, Wed, Thu, Fri

Working Hours Start: 08:00 AM

Working Hours End: 05:00 PM

Job Schedule: Full-time

Job Type: Standard

Employee Status: Regular

Employee Group/Union Affiliation: NUE-NCAL-09|NUE|Non Union Employee

Job Level: Individual Contributor

Department: Oakland Reg - 1800 Harrison - RevCycle lntegrtt Cdr Tmg/Aud - 0208

Pay Range: $109300 - $141350 / year

The ranges posted above reflect the location in the job posting. The salary range may vary if you reside in a different location or state than the location posted.

Travel: No

At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.

Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

Submit Interest