The EIO Medical Documentation Auditor ensures accurate & complete documentation through compliance & encounter audits & clinician feedback. Provides documentation feedback to clinicians from E&M, CPT & ICD9 audits conducted by EIO auditors using all state/federal & 3rd party payor regulatory standards for both inpatient & outpatient groups.
- Using Kaiser Permanente auditing tools, conduct concurrent & retrospective audits of documentation supporting E/M, CPT & ICD9 codes assigned by clinical staff.
- Researches correct coding practices in relationship to applicable rules, regulations & coding conventions for billing to determine compliance w/ Federal, State & Kaiser Permanente regulations.
- Using independent judgment & sensitivity, reviews w/ individual physicians their audit findings, making suggestions for documentation improvements.
- Provides feedback to clinicians based on Federal & State government billing & coding guidelines.
- Plans, schedules & performs comprehensive chart audits to identify operational & regulatory issues related to coding, documentation, & compliance requirements & ensure complete & accurate data capture in compliance w/ Federal & State requirements.
- Works w/ Medical Center auditing teams to ensure compliance w/ Federal, State & Kaiser Permanente requirements.
- Designs & implements methodologies to ensure accurate & complete E&M, CPT & ICD9 coding audits.
- Provides technical expertise to Regional & local leadership to identify & resolve coding & chart documentation problems impacting the accuracy & consistency of coded data.
- Works w/ local Trainers to address operational processes that hinder encounter data capture.
- Reads & interprets medical data written by providers.
- Enters audit results into regional audit tools to support quality assurance process, regional analysis & regional training activities.
- Reviews analytical data & audit findings to identify coding trends & other risk areas. Recommends appropriate actions.
- Conducts quality assurance reviews.
- Collaborates in the development & execution of local audit & training plans.
- Partners w/ the EIO Managers to identify audit trends & risk areas based on audit findings & data analysis.
- Assists in developing & implementing policies & procedures / Compliance Audit Standards to ensure compliance w/ Federal, State & other regulatory requirements.
- Travel throughout the Northern California region based on operational needs may be required.
- In addition to the standard auditor accountabilities, the EIO Auditor is also responsible for conducting Claims & Referral audits.
- Responsible for independently implementing the end to end audit process for claims & referrals following established objectives w/ expected completion & accuracy goals.
- Partners w/ 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 & travel to offsite locations.
- Develops a strategy to get access to pertinent medical record information & all supporting documents that need to be audited.
- Conducts audit independently on-site per audit objectives & guidelines.
- Proficiency in Excel and Access (Candidate will utilize these software tools to perform in-depth analytical review of codes and provide outcomes in clear concise manner)
- Three (3) or more years CPT, ICD9 & E&M Coding experience.
- Experience using PC applications such as MS Word, Excel, Access & PowerPoint.
- Demonstrated experience conducting Medical Record audits & ability to interpret & apply Federal & State regulations, coding & billing requirements.
- Experience using Epic electronic health record systems preferred.
- Experience using Web based applications preferred.
- Medical center operations or clinical experience preferred.
- Bachelor's degree in business administration, health care, public health, finance, business medical records technology or equivalent experience.
- Certification in one (1) 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).
- Proficient in the use of CPT, ICD9 & HCPCS coding principles.
- Comprehensive knowledge of medical diagnostic & procedural terminology is required.
- Demonstrated ability to constructively & sensitively provide feedback to providers & medical center leadership regarding federal & state coding, medical documentation & compliance guidelines, audit results & risk areas.
- Ability to work w/ & maintain confidentiality of physician, patient, patient account & personnel data.
- Knowledge of outpatient coding practices at both the clinical & inpatient settings.
- Required knowledge of compliance & regulatory requirements including outpatient CMS regulations.
- Strong interpersonal & excellent written, verbal & presentation skills.
- Demonstrated ability to work independently w/ minimal supervision.
- Ability to prioritize workload & meet deadlines.
- Ability to read & 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 & audit findings to identify coding trends & other risk areas.
- Demonstrated ability to develop data requirements & work w/ analytical groups to extract, organize & analyze coded data.
- Must be able to work in a Labor / Management Partnership environment.
ICD9, CPT and E&M Coding skills assessment will be given to all applicants.
Kaiser Permanente - 14 months ago
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