Kaiser Permanente Clinical and Documentation Review Consultant in Oakland, California

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

Basic Qualifications:Experience- Minimum five (5) years of acute care, inpatient, outpatient, DRGs, HCCs and APCs coding required.- Minimum two (2) years of acute care, inpatient, outpatient, DRGs, HCCs and APCs auditing 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:- Understanding of state/federal regulations that impact coding and reimbursement.- Demonstrated strong interpersonal and communication skills.- Provide 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 coding systems.- Knowledge of computerization and technological advances in health information.- Familiarity with important areas such as privacy, security and confidentiality impacting sharing of clinical information.- Must be able to work in a Labor/Management Partnership (union) environment.

Preferred Qualifications:- Minimum one (1) year of experience using electronic health records (EHR).

  • Bachelor's degree in health information management, business administration, healthcare administration or other related field.- AHIMA Certified ICD-10 trainer preferred.- CCDS credential preferred.- CDIP credential preferred.


TITLE: Clinical and Documentation Review Consultant

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.