Description: SEIU Local 105 - $31.79 - $43.20
 “May be entitled to translation/bilingual, shift or other wage premiums as governed by the applicable collective bargaining agreement. Please refer to the respective collective bargaining agreement for additional information on such wage premiums: https://www.lmpartnership.org/local-contracts.       

Job Summary:

Provides documentation review, coding, and data abstracting of medical service documentation to ensure that Kaiser Permanente Colorado receives appropriate reimbursement and conforms to applicable guidelines and regulations. Serves as a technical coding expert.

Essential Responsibilities:

This position, knows and complies with all Kaiser Permanente quality, safety, and emergency policies and procedures. Demonstrates quality and effectiveness in work habits and clinical practice in every interaction with patients, colleagues, providers, and leadership. Ensures patient safety in the preparation and provisioning of care related to but not limited to medications, procedures, infection prevention, fall prevention, including consistent use of two patient identifiers and procedural time outs. Reports safety hazards, accidents and incidents, and unsafe working conditions promptly.
Reviews provider assigned coding of level of service (CPT-4), diagnosis (ICD-10CM), and procedures (CPT-4 and HCPCS) of Kaiser Permanente Commercial encounters, Government payers, and third party billable encounters. Corrects and resubmits claims based on review of the record. Escalates to appropriate staff for further coding review if necessary. Assigns appropriate coding of level of service (CPT-4), diagnosis (ICD-10CM), and procedures (CPT-4 and HCPCS) based on review of the entire clinical record. Provides additional support to the coding staff by resolving complex cases and issues. Maintains a sustained level of 95% coding accuracy and productivity to support auditing and feedback schedules and comply with department standards. Contributes to the development and maintenance of specialty specific education materials.
Maintains current knowledge of coding conventions, guidelines, updates, and regulations governing government and third party billing to ensure that Kaiser Permanente Colorado coding and documentation meets regulatory guidelines and audit standards, and results in appropriate reimbursement. Must meet and maintain departmental quality and production standards. Must maintain all certifications required by this position. Collaborates with electronic medical record team to develop and implement strategies to make appropriate documentation, and bill editing as efficient as possible. Participates as needed in the testing and training of new system applications. Collaborates with clinical and non-clinical groups, to develop, implement and communicate specific coding and documentation guidelines that will fulfill the internal needs for complete and consistent clinical data. Serves as coding expert on various committees as requested.
Supports compliance and Kaiser Permanents Code of Conduct by adhering to federal and state laws and regulations, accreditation and license requirements, by policies and procedures. Responds appropriately to observed fraud and abuse.
Basic Qualifications:
Experience

Minimum Two (2) years of outpatient or inpatient coding experience using ICD-10, CPT-4, and HCPCS, including Medicare, Medicaid, and third party liability billing required.
Per the National Agreement, current KP Coalition employees have this experience requirement waived.

Education

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

License, Certification, Registration

Certified Professional Coder from American Academy of Professional Coders OR Certified Coding Specialist from American Health Information Management Association

Additional Requirements:

Demonstrated ability to understand the clinical content of a health record including complicated records.
Above average written and communication skills with the ability to present, explain, and write information in a clear, concise, and organized format.
Must be able to work with a variety of healthcare professionals at all levels.
Ability to communicate with physicians and non-physician staff with a commitment to provide quality customer service.
Working knowledge of medical specialties, including clinical conditions seen and procedures performed.
Demonstrated ability to use spreadsheet and word processing applications.
Must maintain all certifications required by this position.
Must be able to work in a Labor/Management Partnership environment.

Preferred Qualifications:

Working knowledge of electronic medical record systems preferred.

Notes:

Must live in Colorado