Medical Documentation Auditor
Company: Kaiser Permanente
Location: Oakland
Posted on: June 24, 2022
Job Description:
Candidates are required to live locally. Tasks are performed
on-site.
The EIO Medical Documentation Auditor ensures accurate and complete
documentation through compliance and encounter audits and clinician
feedback. Provides documentation feedback to clinicians from
E&M, CPT and ICD9 audits conducted by EIO auditors using all
state/federal and 3rd party payor regulatory standards for both
inpatient and outpatient groups.
Essential Functions:
- Core Audit Responsibilities: Using Kaiser Permanente auditing
tools, conduct concurrent and retrospective audits of documentation
supporting E/M, CPT and ICD9 codes assigned by clinical staff.
Researches correct coding practices in relationship to applicable
rules, regulations and coding conventions for billing to determine
compliance with Federal, State and Kaiser Permanente regulations.
Using independent judgment and sensitivity, reviews with individual
physicians their audit findings, making suggestions for
documentation improvements. Provides feedback to clinicians based
on Federal and State government billing and coding guidelines.
Plans, schedules and performs comprehensive chart audits to
identify operational and regulatory issues related to coding,
documentation, and compliance requirements and ensure complete and
accurate data capture in compliance with Federal and State
requirements.
- Permanente requirements. Designs and implements methodologies
to ensure accurate and complete E&M, CPT and ICD9 coding
audits. Provides technical expertise to Regional and local
leadership to identify and resolve coding and chart documentation
problems impacting the accuracy and consistency of coded data.
Works with local Trainers to address operational processes that
hinder encounter data capture. Reads and interprets medical data
written by providers.
- Enters audit results into regional audit tools to support
quality assurance process, regional analysis and regional training
activities. Reviews analytical data and audit findings to identify
coding trends and other risk areas. Recommends appropriate actions.
Conducts quality assurance reviews. Collaborates in the development
and execution of local audit and training plans. Partners with the
EIO Managers 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.
Travel throughout the Northern California region based on
operational needs may be required.
- Specific Audit Responsibilities - Claims and Referrals. In
addition to the standard auditor accountabilities, the EIO Auditor
is also responsible for conducting Claims and Referral audits.
Responsible for independently implementing the end to end audit
process for claims and referrals following established objectives
with expected completion and accuracy goals. Partners with 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 and travel to offsite locations.
Develops a strategy to get access to pertinent medical record
information and all supporting documents that need to be audited.
Conducts audit independently on-site per audit objectives and
guidelines.
Basic Qualifications:
Experience
- Minimum three (3) years CPT, ICD9 & E&M Coding
experience.Education
- Bachelor's degree in business administration, health care,
public health, finance, business medical records technology OR four
(4) years of experience in a directly related field.
- High School Diploma or General Education Development (GED)
required.License, Certification, Registration
- Certification in one 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).
Additional Requirements:
- Experience using PC applications such as MS Word, Excel,
Access, PowerPoint.
- Demonstrate experience conducting Medical Record audits and
ability to interpret and apply Federal and State regulations,
coding and billing requirements.
- Proficient in the use of CPT, ICD9 and HCPCS coding
principles.
- Comprehensive knowledge of medical diagnostic and procedural
terminology is required.
- Demonstrated ability to constructively and sensitively provide
feedback to providers and medical center leadership regarding
federal and state coding, medical documentation and compliance
guidelines, audit results and risk areas.
- Ability to work with and maintain confidentiality of physician,
patient, patient account and personnel data.
- Knowledge of outpatient coding practices at both the clinical
and inpatient settings.
- Required knowledge of compliance and regulatory requirements
including outpatient CMS regulations.
- Strong interpersonal and excellent written, verbal and
presentation skills.
- Demonstrated ability to work independently with minimal
supervision.
- Ability to prioritize workload and meet deadlines.
- Ability to read and 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 and audit
findings to identify coding 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 work in a Labor / Management Partnership
environment.
Preferred Qualifications:
- Experience using Epic electronic health record systems
preferred.
- Experience using Web based applications preferred.
- Medical center operations or clinical experience preferred.
PrimaryLocation : California,Oakland,1950 Franklin
HoursPerWeek : 40
Shift : Day
Workdays : Mon, Tue, Wed, Thu, Fri
WorkingHoursStart : 06:00 AM
WorkingHoursEnd : 02:30 PM
Job Schedule : Full-time
Job Type : Standard
Employee Status : Regular
Employee Group/Union Affiliation : NUE-NCAL-09-NUE-Non Union
Employee
Job Level : Individual Contributor
Job Category : Medical Records,Health Information Management
Department : Oakland Reg - 1950 Franklin -
RgnlMG-Codg-Auditig&ConsultSvc - 0206
Travel : No
Kaiser Permanente is an equal opportunity employer committed to a
diverse and inclusive workforce. Applicants will receive
consideration for employment without regard to race, color,
religion, sex (including pregnancy), age, sexual orientation,
national origin, marital status, parental status, ancestry,
disability, gender identity, veteran status, genetic information,
other distinguishing characteristics of diversity and inclusion, or
any other protected status.
Keywords: Kaiser Permanente, Oakland , Medical Documentation Auditor, Healthcare , Oakland, California
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