In-House Medical Coding Reviewer
SUMMARY Perform regular encounter audits which ensure documentation meets requirements for diagnosis and E&M assignment, based on Official ICD-10-CM Documentation Guidelines and regulatory requirements. RESPONSIBILITIES Regular Encounter audits. Encounter Audits will be the primary monitoring tool used to identify operational and regulatory issues related to coding, documentation, and compliance requirements and to ensure complete and accurate data capture in compliance with Federal and State requirements. Enters encounter audit results into regional audit database to support quality assurance process, regional analysis and regional training activities. Prepares and/or performs auditing analysis and/or special projects as assigned. Partners with Trainer(s) in the development of future training that will address documentation risk areas identified through audits. Conducts both Medicare, E/M, and Procedure audits on an as-needed basis. Assists in the identification of operational processes that hinder encounter data capture. Partners with Data Quality Trainer and other analytical workgroups 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. Through the use of Kaiser systems, specifically Kaiser Permanente Health Connect, researches plans for data gathering and analysis; participates significantly in interpreting analyses and developing action plans accordingly. Other duties as assigned. QUALIFICATIONS Bachelor's degree in business administration (health care, public health, finance, business medical records technology) preferred. High School Diploma or General Education Development (GED) required with equivalent experience. Certification in one of the following: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Professional Coder (CPC). Minimum of 1 year of experience coding based on Coding Clinical Guidelines. Three (3) years of experience coding based on Coding Clinical Guidelines for inpatient and outpatient, preferred. Project management experience including design and implementation of audit plans. Preferred: three (3) years experience conducting Medical Record audits. Ability to interpret and apply Federal and State regulations, coding and billing requirements. Ability to work with and maintain confidentiality of physician, patient, patient account and personnel data. Strong interpersonal and excellent written, verbal and presentation skills. 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 documentation 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 pass proficiency exam.