SHSMD Career Center

Develop coding and presentation skills to provide training, consultation, audit, and feedback to clinicians on their medical service documentation and coding to ensure that Kaiser Permanente Northwest (KPNW) receives appropriate reimbursement and conforms to applicable guidelines and regulations.

Join our medical group

Northwest Permanente is a self-governed, physician-led, multi-specialty group of 1,500 physicians, surgeons, and clinicians, caring for 630,000 members in Oregon and Southwest Washington. Kaiser Permanente is one of the nation's preeminent health care systems, a benchmark for comprehensive, integrated, value-based, and high-quality care.

Major Accountabilities

• Research coding guidelines and develop skills to provide expert consultation to specialists and primary care clinicians as assigned on coding and documentation questions
• Within assigned clinical specialties, maintain current knowledge to ensure that KPNW coding and documentation meets regulatory guidelines and audit standards utilizing the support of the Coding Consultant or Coding Supervisor
• Sequence all codes appropriately using coding rules and guidelines
• Research new diagnostic and procedure codes utilizing CPT4, ICD-10 and HCPCS codes and assigns codes as appropriate
• Review and verify component parts of the medical records to ensure the accuracy of diagnostic and therapeutics procedures is complete and conforms to CMS coding rules and guidelines under the direction of the Coding Consultant or Coding Supervisor
• Provide support to Coding Consultant to present 20 minutes of material within a lunchtime team meeting, as well as up to 4 hours of medical specialty specific training or as part of the New Hire Clinician training team
• Carefully analyze and chooses educational presentation training points to emphasize, ensuring training is relevant and meets provider needs appropriately to improve or maintain consistent and accurate provider code selection under the direction of the Coding Consultant or Coding Supervisor
• Utilize appropriate department resources and processes (i.e. discussions with team members) when code assignment is not straightforward or documentation is inadequate, ambiguous or unclear for coding purposes
• Under the direction of the Coding Supervisor, perform periodic quality audits of documentation and coding in EpicCare
• Review and verify information (such as POS, attending provider) to make sure the transaction of medical data is complete and accurate, under the direction of the Coding Supervisor or Coding Consultant
• Analyze audit results and provide summary feedback under the direction of the Coding Supervisor, to individual clinicians, making recommendations for improvement by providing coding education
• Create and maintain tools to audit professional coding service data
• Apply consistent coding practice standards when conducting chart audits, using good judgment in preparing individualized recommendations for improvement under the direction of the Coding Supervisor or Coding Consultant
• Use overall audit data results to develop topics for future department training opportunities for physician and coders, under the direction of the Coding Supervisor or Coding Consultant
• Shadow and develop skillset to provide onsite specialty specific training to individuals or groups of clinicians regarding documentation of services and appropriate coding of level of service, diagnoses, and procedures; including tips and techniques to help clinicians work more efficiently in KP Health Connect
• Contribute to the development and maintenance of specialty-specific coding education materials under supervision of the Coding Consultant or Coding Supervisor
• Respond to or clarify internal requests for coding information under supervision of the Coding Consultant or Coding Supervisor
• Develop system skillset to collaborate with the KP Health Connect team and provide recommendations to develop and implement strategies to make appropriate documentation and coding more efficient for clinicians, under the direction of the Coding Supervisor or Coding Consultant
• Participate in development of organizational procedures and updates of forms and manuals
• Willingness to work evenings or weekends to meet client goals
• Perform other duties as requested

Minimum Qualifications

• Ability to evaluate, analyze, compute, and summarize mathematical statistics related to medical record audits performed with ability to prepare materials to present findings, trends, outcomes under supervision of the Coding Consultant or Coding Supervisor
• Ability to learn and comprehend importance of conducting coding audits to evaluate quality performance measures and using the findings, create written reports with recommendations; and then develop skills to present education and feedback to facilitate improvement of documentation and coding
• Gain understanding of medical terminology, pharmacology, body systems/anatomy, physiology and concepts of disease processes during training and enrolled course work
• Gain understanding of ICD-10, CPT and HCPCS and Evaluation and Management coding guidelines under supervision and guidance of the Coding Consultant or Coding Supervisor
• Attention to detail and completeness with a thorough understanding of government rules and regulations and areas of scrutiny for potential areas of risk for fraud and abuse in regard to coding and documentation
• Computer experience and ability to learn new computer applications quickly and independently, including: EMR(s), Microsoft Office Suite and other software programs
• Ability to manage a significant workload and to work efficiently under pressure meeting established deadlines under supervision of the Coding Consultant or Coding Supervisor
• Communicates in a clear and understandable manner; exercises independent judgment; influence and coordinate the efforts of others over whom one has no direct authority
• Attend workshops to keep abreast of current trends and changes in the laws and regulations governing medical record coding and documentation to minimize the risk of fraud and abuse and to optimize revenue recovery
• Abide by the Standards of Ethical Coding as set forth by AHIMA and AAPC
• Meet department standards for performance and quality; maintains an acceptable level of accuracy rate based on monthly results

Minimum Education & Experience

• High school diploma or equivalent
• Currently enrolled in or completed college course work for coding and/or communication course or equivalent work experience in Healthcare field

Required license, registration, certification or professional affiliation

• Must complete and attain certification within 12 months of hire date. Preferred and acceptable certification/licenses are CPC, CCS-P, RHIT

Preferred Experience

• Minimum of two (2) years extensive auditing experience with demonstrated ability to provide effective statistical analysis and analytical problem solving
• Minimum of one (1) year experience in multispecialty professional services coding using ICD-10, CPT and HCPCS, Evaluation and Management coding, including Medicare
• Minimum of one (1) year experience with project management functions and presenting education and training feedback to small and large groups

Preferred Qualifications

• Bachelor Degree in Health Information Management or equivalent education or years of experience directly related to the duties and responsibilities
• Comprehensive knowledge and proficiency in ICD-10, CPT and HCPCS coding
• Advanced proficiency in use of Microsoft Office Suite of products and other software programs to document and manage audit data

Equal opportunity employer

At Northwest Permanente, we are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants without regard to race, color, religion, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical and mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military and veteran status, and any other characteristic protected by applicable law. Northwest Permanente believes that equity, inclusion, and diversity among our employees are critical to our success, and we seek to recruit, develop, and retain the most talented people from a diverse candidate pool.