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Kaiser Permanente Medical Doc. Auditor - NCAL in Oakland, California

The EIO Medical Documentation Auditor ensures accurate and complete documentation through compliance and encounter audits and clinician feedback. Provides documentation feedback to clinicians from E&M, CPT and ICD9 audits conducted by EIO auditors using all state/federal and 3rd party payor regulatory standards for both inpatient and outpatient groups.

Essential Functions:

  • Core Audit Responsibilities: Using Kaiser Permanente auditing tools, conduct concurrent and retrospective audits of documentation supporting E/M, CPT and ICD9 codes assigned by clinical staff. Researches correct coding practices in relationship to applicable rules, regulations and coding conventions for billing to determine compliance with Federal, State and Kaiser Permanente regulations. Using independent judgment and sensitivity, reviews with individual physicians their audit findings, making suggestions for documentation improvements. Provides feedback to clinicians based on Federal and State government billing and coding guidelines. Plans, schedules and performs comprehensive chart audits to identify operational and regulatory issues related to coding, documentation, and compliance requirements and ensure complete and accurate data capture in compliance with Federal and State requirements.

  • Permanente requirements. Designs and implements methodologies to ensure accurate and complete E&M, CPT and ICD9 coding audits. Provides technical expertise to Regional and local leadership to identify and resolve coding and chart documentation problems impacting the accuracy and consistency of coded data. Works with local Trainers to address operational processes that hinder encounter data capture. Reads and interprets medical data written by providers.

  • Enters audit results into regional audit tools to support quality assurance process, regional analysis and regional training activities. Reviews analytical data and audit findings to identify coding trends and other risk areas. Recommends appropriate actions. Conducts quality assurance reviews. Collaborates in the development and execution of local audit and training plans. Partners with the EIO Managers to identify audit trends and risk areas based on audit findings and data analysis. Assists in developing and implementing policies and procedures / Compliance Audit Standards to ensure compliance with Federal, State and other regulatory requirements. Travel throughout the Northern California region based on operational needs may be required.

  • Specific Audit Responsibilities - Claims and Referrals. In addition to the standard auditor accountabilities, the EIO Auditor is also responsible for conducting Claims and Referral audits. Responsible for independently implementing the end to end audit process for claims and referrals following established objectives with expected completion and accuracy goals. Partners with Provider Contracting to assess status of claims based on whether associated vendor is a contracted or non-contracted partner. Negotiation approach will need to be tailored to the type of vendor.

  • Manage vendor relationship to get access to documentation which requires client management skills and travel to offsite locations. Develops a strategy to get access to pertinent medical record information and all supporting documents that need to be audited. Conducts audit independently on-site per audit objectives and guidelines.

Basic Qualifications:

Experience

  • Minimum three (3) years CPT, ICD9 & E&M Coding experience.

Education

  • Bachelor's degree in business administration, health care, public health, finance, business medical records technology OR four (4) years of experience in a directly related field.

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

License, Certification, Registration

  • Certification in one of the following: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Certified Professional Coder- Hospital (CPC-H).

Additional Requirements:

  • Experience using PC applications such as MS Word, Excel, Access, PowerPoint.

  • Demonstrate experience conducting Medical Record audits and ability to interpret and apply Federal and State regulations, coding and billing requirements.

  • Proficient in the use of CPT, ICD9 and HCPCS coding principles.

  • Comprehensive knowledge of medical diagnostic and procedural terminology is required.

  • Demonstrated ability to constructively and sensitively provide feedback to providers and medical center leadership regarding federal and state coding, medical documentation and compliance guidelines, audit results and risk areas.

  • Ability to work with and maintain confidentiality of physician, patient, patient account and personnel data.

  • Knowledge of outpatient coding practices at both the clinical and inpatient settings.

  • Required knowledge of compliance and regulatory requirements including outpatient CMS regulations.

  • Strong interpersonal and excellent written, verbal and presentation skills.

  • Demonstrated ability to work independently with minimal supervision.

  • Ability to prioritize workload and meet deadlines.

  • Ability to read and interpret medical data.

  • Demonstrated ability to work within a team environment.

  • Willingness to be flexible depending upon department and/or physician schedule needs.

  • Demonstrated ability to review analytical data and audit findings to identify coding trends and other risk areas.

  • Demonstrated ability to develop data requirements and work with analytical groups to extract, organize and analyze coded data.

  • Must be able to work in a Labor / Management Partnership environment.

Preferred Qualifications:

  • Experience using Epic electronic health record systems preferred.

  • Experience using Web based applications preferred.

  • Medical center operations or clinical experience preferred.

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.

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 and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.

COMPANY: KAISER

TITLE: Medical Doc. Auditor - NCAL

LOCATION: Oakland, California

REQNUMBER: 878645

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.

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