Coding Compliance Auditor

Job Summary

HIM Coding auditor/trainer will coordinate, monitor, and audit documentation and coding of inpatient and/or outpatient services in all applicable health care settings. Audits will focus on correct assignment of CPT, ICD-10, ICD-9- CM, HCPSC codes and clinician documentation to ensure that Kaiser Permanente is compliant with all regulatory guidelines and internal controls. Audits will encompass internal practitioners, contracted practitioners, coders, internal facilities and contracted facilities.

The auditor will analyze audit results, identify patterns, trends or variations in coding and documentation practices and make recommendations for improvement. When necessary, this position will initiate corrective action plan to ensure resolution of problem areas identified during auditing and monitoring activity. This position will serve as a liaison with HIM staff, Revenue Cycle, External and Internal practitioners, and other regional departments as appropriate including but not limited to IT, benefits, etc.

• Reviews and audits coders based on federal regulatory requirements [e.g. the Centers for Medicare and Medicaid Services (CMS)] and current documentation and coding guidelines, as well as ensuring compliance with departmental/internal policies and other applicable laws and regulations.
• Prepare written audit report for all noted deficiencies and make recommendations to Coding and Revenue Cycle Compliance Manager, HIM director and others as appropriated/requested (i.e. training, oversight, monitoring, process flows, etc.). Conducts trend analyses to identify patterns and variations in coding practices and case-mix index.
• Develop and deliver education and training programs related to results of document and coding reviews, and findings from RAC and other regulatory audits.
• Compares coding and reimbursement profile with regional and national norms. Reviews coding claim denials and rejections.
• Receives and investigates reports of compliance violations. Communicates results to HIM director and compliance officer. Ensures appropriate dissemination and communication of all regulation, policy, and guideline changes to affected personnel.

• Experience
  • Minimum four (4) years inpatient coding experience in an acute care setting, including experience with ICD-10, ICD-9-CM, CPT4 and HCPCS coding systems, UHDDS definitions, and other related documentation requirements.
• Education
  • Bachelors degree in healthcare, health information management or related field OR four (4) years of directly related experience.
• License, Certification, Registration
  • Certified Coding Specialist from American Health Information Management Association OR Registered Health Information Administrator from American Health Information Management Association OR Certified Professional Coder from American Academy of Professional Coders OR Registered Health Information Technician from American Health Information Management Association.

• Must possess a proficient understanding of the Inpatient and Outpatient Prospective Payment Systems (IPPS OPPS), Medical Severity Diagnosis-Related Groups(MS-DRG), and National Correct Coding Initiative Edits (NICCI), ICD- CM Official Guidelines for Coding and Reporting and Coding Clinic.
• Working knowledge of relevant federal and state regulations, Medicare guidelines, and compliance issues.
• Advanced understanding of medical terminology, pharmacology, body systems/anatomy, physiology and concepts of disease.processes.
  
  Demonstrated knowledge of and skill in data collection, statistical analysis, and/or interpretation.
• Demonstrated knowledge of and skill in oral communication, written communication, problem solving, analysis, project management, quality management, systems thinking, group presentations, group process facilitation, influence, and customer service.
• Demonstrated knowledge of and skill in word processing, spreadsheet, and database PC applications.
• Demonstrated knowledge of and skill in decision making, customer service, influence, interpersonal relations, oral communication, problem solving, project management, quality management, results orientation, systems thinking, teamwork, written communication, team building/leadership, and change management.

• Completion of an accredited Health Information Management program.