Experience Inc. Jobs

Job Summary:

At the enterprise level, assures compliance with coding guidelines, guidance documents, policies, and procedures. Plans, and performs coding quality reviews/audits, develops educational presentations/webinars and provides education to the Enterprise. Supports manager and director in developing annual coding education workplan, and monitors compliance of same.

Conducts concurrent and/or retrospective coding quality and documentation integrity reviews/audits impacting revenue cycle. Assists all stakeholders with coding and documentation integrity questions and provides guidance on coding and documentation related issues/topics. Participates and supports in the development and presentation of coding education webinars or in-service as needed.

Supports physician documentation and diagnosis code selection/service capture processes, in alignment with regulatory standards and official coding guidelines

Essential Responsibilities:

• Enterprise Coding Quality Education

• Coordinates the monitoring processes and conducts audits on all services and lines of business. Including Clinical Documentation Integrity programs, Hospital Inpatient/Outpatient and Professional Fee coding and abstracting.

• Support manager/director in monitoring the accuracy and quality of coding audit assignments and conducts internal focus reviews/audits and Review of the Reviewer activities.

• Develops and presents coding and compliance education webinars and provides education related to focused projects including coding trend opportunities.

• Provides oversight and support for use of the Enterprise Quality Review/Audit (iCA - Integrated Coding Assurance) Tool.

• Supports the Coding Quality Monitoring Advisory Group (CQMAG) and Educational Advisory Group (EAG) processes and procedures.

• Enterprise Education and Coding Compliance

• Supports the enterprise professional and hospital coding operations in all Coding related audits by providing education to support audit findings.

• Monitors and coordinates coding and documentation integrity and provides education to support coding integrity.

• Provide Enterprise dashboards and metric analytics related to education, trends and opportunities to enhance coding performance.

• Conducts data and root cause analysis on coding trends and educational opportunities, provides feedback and shares findings with Revenue and Coding Integrity Services leaders.

• Create and presents educational outcomes and findings related to audits to leadership and all stakeholders.

• Develops and maintains the Coding Integrity Services SharePoint site.

• Enterprise Coding and Documentation Awareness

• Provides expertise in education and training on coding and documentation issues identified during quality reviews/audits

• Collaborates with the coding staff in the developing programs which provide alignment with education for internal customers to enhance physician documentation and comply with coding guidelines.

• Enterprise Quality Review/Audit Coordination

• Supports manager/director in coordinating and monitoring of exit interviews and partners with the coding operations and risk management teams in performing outcomes management

• Functions as a liaison for other departments regarding coding education, coding questions and issues.

  Basic Qualifications:

  Experience

• Minimum of five (5) years of professional fee and/or hospital acute care coding required

• Minimum of three (3) years of professional fee and/or hospital acute care quality review/auditing required

  Education

• Associate degree or Certification in Professional Coding, Health Information Management, Business Administration, Healthcare Administration, or other related field or Two (2) years experience in a related field.

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

  License, Certification, Registration

• Registered Health Information Technician within 3 months of hire OR Certified Professional Coder within 3 months of hire OR Certified Coding Specialist within 3 months of hire OR Certified Outpatient Coder within 3 months of hire OR Registered Health Information Administrator within 3 months of hire OR Certified Inpatient Coder Certification within 3 months of hire

  Additional Requirements:

• Understanding of state/federal regulations that impact coding and reimbursement

• Demonstrated strong interpersonal and communication skills

• Provide expertise for high quality in-service and seminar of coding and coding related topics and clinical documentation integrity

• Working knowledge of Hierarchical Condition Category (HCC) coding and reimbursement methodology

• Current knowledge of ICD and CPT (Current Procedural Terminology) coding systems

• Knowledge of computerization and technological advances in health information

• Familiarity with privacy, security and confidentiality impacting sharing of clinical information

• Must be able to work in a Labor/Management Partnership (union) environment

  Preferred Qualifications:

• CCDS (Certified Clinical Documentation Specialist) credential preferred

• CDIP (Certified Documentation Improvement Practitioner) credential preferred

• Bachelors degree in health information management, Business Administration, Healthcare Administration, or another related field

COMPANY: KAISER

TITLE: Enterprise Coding Quality Review Manager

LOCATION: Oakland, California

REQNUMBER: 1307478

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.