Job Summary:
With minimal supervision, coordinates and conducts code assignments and validation for KFHP professional services and procedures. Utilizes established documentation and coding criteria based on the National Cooperating Party Guidelines and Standards. Responsible for concurrent analysis of coding for all professional evaluation/managementand procedural encounters and provides coding assistance through interpretation of guidelines and query/communication to practitioner. Performs coding assignment and validations and prepares queries for practitioners on their medical service for all practice locations (all Medical Office Buildings). Ensures the organization submits compliant, accurate, and complete clinical encounters for appropriate reimbursement. Conforms to applicable guidelines and regulations (Federal, State, and Internal) and Serves as a liaison with TSPMG staff, NMF, external and internal practitioners, and other regional departments as appropriate including but not limited to IT, benefits, etc.

Essential Responsibilities:

Assign appropriate E&M, diagnosis, and procedure codes following coding guidelines for the most current version of ICD-CM, CPT, and HCPCS Level II for patient encounters.

Provide expert consultation to other KPSE (Georgia) staff seeking coding advice.

Provide consultation to any KP MD as assigned on all coding and documentation questions. Within assigned clinical specialties, maintain current knowledge to ensure that KPSE (Georgia) coding and documentation meets regulatory guidelines and audit standards, and results in appropriate reimbursement.

Maintains up-to-date knowledge regarding professional health information practices, as well as standards and regulatory requirements related to health information management and coding compliance (Federal, State, internal).

Supports team members who participate in task force groups regarding health information and coding issues.

Ability to accurately assess complex specialty code assignment and submissions including but not limited to General Surgery, Plastic Surgery, Gastroenterology, OB/Gyn, Urology, Orthopedics, Nephrology, ENT, Ophthalmology Minimum accuracy rate of 90%. Team is audited monthly 10 encounters per coder.

Identify, report, and resolve issues through partnership with clinicians, department administration, and other coding staff to reduce denials and improve time to submission.

Achieves and maintains departmental productivity standards.

Maintaining objectivity and professional credibility overall.

Consistently supports compliance and the Principles of Responsibility (Kaiser Permanentes Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state and local laws and regulations, accreditation and licenser requirements (if applicable), and Kaiser Permanentes policies and procedures.

Your access to protected health information (PHI) will be limited to the minimum necessary required to effectively perform your job.

In addition to defined technical requirements, you will be accountable for consistently demonstrating service behaviors and principles defined by the Kaiser Permanente Service Quality Credo, the KP Promise, and specific departmental/organizational initiatives. You also will be accountable to consistently demonstrate the knowledge, skills, abilities, and behaviors necessary to provide superior and culturally sensitive service to each other, to our members, and to purchasers, contracted providers and vendors.

Maintenance and fulfillment of all required CEUs to maintain credentials through AHIMA or AAPC is required.

Maintains appropriate coding certifications as outlined in educational and certification requirements.

Partners with TSPMG Documentation and Coding department to coordinate accurate documentation and coding information.

Will assure compliance with applicable federal, state and local laws and regulations, The Principles of Responsibility, the Code of Conduct for KP, internal policies and procedures, professional standards and accreditation standards.

May perform other duties as assigned.

Basic Qualifications: Experience

Minimum six (6) months of experience in direct coding assignment and validation experience in a multidisciplinary environment.

Minimum three (3) year of experience in the coding field with strong focus on E/M and procedural coding.

Education

Bachelors Degree or four (4) years of experience in a directly related field.
High School Diploma or General Education Development (GED) required.

License, Certification, Registration

Certified Professional Coder - Hospital Outpatient OR Certified Coding Specialist - Physician Based OR Certified Professional Coder

Additional Requirements:

Additional experience in reimbursement and/or billing functions will be valuable.
Knowledge of Medical Records documentation guidelines - 1997.
Excellent oral and written communication skills.
Ability to work well with physicians.
Requires in-depth knowledge of the most current version of ICD-CM and CPT Coding systems and knowledge of HCPCS Level II coding system.
Working knowledge of medical terminology, disease processes, and pharmacology.
Highly organized, self-motivated individual who can work independently with minimal supervision.
Excellent time management and problemsolving skills.
Ability to work well with others with diverse backgrounds and at various organizational levels.
Ability to work well within a team.
Experience must include work opportunities that have allowed for the evolution of a strong procedural coding background.
Ability to use multiple systems to access and conduct clinical documentation / coding assignment and validation-U.
Must attain and maintain 95% accuracy level within 6 months of hire.
Working knowledge of medical terminology, anatomy and pathophysiology.
Knowledge of third party reimbursement regulations and billing practices (i.e. CMS, HMO and other commercial payers).
Knowledge of governmental standards and guidelines applicable to coding and billing.
Expertise in Microsoft office suite.
Knowledge of Epic a plus.

Preferred Qualifications:

Minimum one (1) year of coding experience at one of the following coding levels: facility inpatient, outpatient, and professional services.
Minimum one (1) year of work experience in an outpatient surgical healthcare setting utilizing electronic medical records and coding processes.
Bachelors Degree in Health Information Management Systems or Health Management or four (4) years of experience in a directly related field.