Coding Auditor – Facility KPNW

By | January 14, 2023

Coding Auditor – Facility KPNW

Coding Auditor – Facility KPNW

Primary Location Clackamas, Oregon

Job Number 1052063

Date posted 07/07/2022

Assigning appropriate diagnostic and procedure codes to the patient’s health information records for records from the Emergency Department (ED), Ambulatory Surgical Center (ASC), Hospital Ambulatory Surgical Center (HAS), Observations (OBS), Inpatient (IP), and other chosen facility records. Maintain an acceptable level of performance for the ICD-10-CM, ICD-10-PCS, and HCPCS/CPT classification and nomenclature systems in terms of quality and productivity. The American Medical Association (CPT), National Correct Coding Initiative (NCCI), Uniform Hospital Discharge Data Set (UHDDS), Medicaid, and the International Classification of Diseases – Official Coding Guidelines for coding and reporting as established by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS) will all be followed (OMAP), and institutional/organizational coding policies of Kaiser Permanente. having the ability to ask doctors for clarification on diagnoses and procedures. Ability to comprehend the clinical information contained in the health record, extract the data from the patient’s health information record, and carry out additional tasks that have been delegated. The new programmer must train on-site for one (1) week or until they meet the department’s requirements, whichever comes first.

Significant Duties:

Proficient at reviewing medical records and converting clinical data into codes. Determine the proper codes to use for diagnoses, procedures, and other rendered services, and validate any Computer Assisted Coding (CAC) assignments for dual coding. Analyzing and maintaining system accuracy, validity, and meaningfulness for both professional and facility services while using the Code Base Charge Trigger system (CBCT) and OPTUM 360 EncoderPRO software system for professional surgical services. uses the clinical information system (EpicCare) and electronic patient data system to retrieve patient encounter data. clinical data elements that are determined by the needs of the organization are abstracted and entered. identifies and assigns the primary diagnosis and procedure codes, arranging them in the appropriate order for the correct Ambulatory Payment Classification (APC), Utilizing the appropriate coding methods, the Medicare Severity-Drug Related Group (MS-DRG), All Patients Refined Diagnosis Related Groups (APR-DRG) assignment. displays understanding and knowledge of CMS HCC Risk Adjustment Code.

Regularly analyzes charts to find parts of the medical file that have documentation that is lacking, wrong, or inconsistent. reviews and confirms the data on the charts (i.e. POS, attending provider). evaluates and enters data. To verify the correctness and completeness of diagnostic and therapeutic treatments that must adhere to CMS coding regulations and guidelines, reviews and verifies component sections of medical records. 95% of departmental standards are met and maintained for productivity and quality.

Employs all of the resources at their disposal, including the Coding Clinic and CPT Assistant, to fully explore coding-related issues. identifies code issues and alerts managers and supervisors as necessary. employs the query process as necessary. helps put solutions into practice that will cut down on back-end code errors. to minimize the risk of fraud and abuse and to maximize revenue recovery, one keeps up with coding and regulatory publications and attends workshops to stay informed about current issues, trends, and changes in the laws and regulations governing medical record coding and documentation.

Maybe lend a hand on particular projects. Keep your conversations private and your interactions with staff productive. exercising independent judgment and being able to speak in a clear and understandable way. Reviews the quarterly Coding Clinic and the monthly CPT Assistant, as well as the annual ICD-10 Official Guidelines for Coding. Participates actively in staff meetings, reporting of performance metrics, quality result monitors, and facility coding services team activities as a team member. May take part in creating organizational policies. attends and takes part in a number of national and regional coding education sessions. Perform other duties as assigned.


Read also employees expected conduct for this job

Basic Qualifications:
  • Minimum two (2) years experience in a directly related coding field or 18 months within the Kaiser Apprentice program.
  • High School Diploma or General Education Development (GED) required.
License, Certification, Registration
  • Certified Coding Specialist OR Registered Health Information Administrator Certificate OR Registered Health Information Technician Certificate


Additional Requirements:
  • Previous experience with EMR patient documentation systems with intermediate knowledge and skill in the use of a computer.
  • Advanced knowledge of disease processes, diagnostic and surgical procedures, ICD-10-CM, ICD-10-PCS, HCPCS/CPT, classification systems, and health information/medical record department responsibilities with knowledge of government regulations and areas of scrutiny for potential fraud and abuse issues.
  • Advanced knowledge of medical terminology, pharmacology, and medial coding principles for ICD-10-CM, ICD-10-PCS, and HCPCS/CPT coding.
  • Fluent in English, demonstrating skill and proficiency in oral and written communication.
  • Skills in time management, organization, and analytical skills.
  • Ability to manage a significant workload and to work efficiently under pressure meeting established deadlines with minimal supervision.
  • Ability to use independent thought and judgment.
  • Abides by the Standards of Ethical Coding as set by the American Health Information Management Association (AHIMA).
  • Meets and maintains department standard for performance, productivity and quality.
  • Final candidates will be required to obtain 75% or better on Kaiser Coding Skills Assessment.
  • Academic knowledge and working experience performing coding and abstracting responsibilities in health information/medical record services.


Preferred Qualifications:
  • Minimum two (2) years of experience in health information/Medical record environment, with facility coding experience that includes Medicare reimbursement guidelines.
  • Degree in Health Information Management.
  • Proficient knowledge and skill in the use of a computer and related system and software to include: EMR(s), Microsoft Office Suite and other software programs.
  • Ability to evaluate, analyze, develop information regarding mathematical statistics and percentages that compare finding trends and outcomes related to productivity and /ore medical record audits.
  • Extensive knowledge of ICD-10 coding guidelines; with knowledge and demonstrated understand of CMS HCC Risk Adjustment coding and data validation requirements.


Primary Location: Oregon,Clackamas,Regional Process Center
Scheduled Weekly Hours: 40Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri
Working Hours Start: 08:00 AM
Working Hours End: 04:30 PM
Job Schedule: Full-time
Job Type: Standard
Employee Status: Regular
Employee Group/Union Affiliation: NUE-NW-02|NUE|Non Union Employee
Job Level: Individual Contributor
Department: Portland Regional Process Ctr – Centralized Medical Records – 1001
Travel: No

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