 Revenue Cycle Auditor IThis position supports Kaiser Permanente’s code of conduct and compliance by adhering to all laws and regulations, accreditation and Licensure requirements, and internal policies and procedures. Kaiser Permanente is proud to be an equal opportunity/affirmative action employer.
DEPARTMENT: REVENUE CYCLE INTEGRITY
SCHEDULE: Full-time Regular; 40 hours per week; Monday through Friday; 8:00am - 5:00pm
POSITION SUMMARY:
This position performs monthly audits of encounters, bills and chart documentation to identify revenue cycle improvement opportunities and areas of potential risk for Inpatient services. This position is responsible for identifying areas of non-compliance in both the areas of coding, charge capture and revenue cycle data collection practices, in addition to quality medical record documentation. Any reported issues resulting from the revenue cycle audit, this position will provide recommendations on appropriate coding, data collection and documentation behaviors. This position will be responsible for adhering to established processes and procedures throughout the organization that maintain billing integrity and compliance. This position will be responsible for maintaining current knowledge of the various regulatory agency guidelines and requirements and will work with staff and providers to ensure that all regulations are met, and that bills are subsequently submitted to a third party with accurate and compliant data.
EDUCATION/LICENSE/CERTIFICATION:
CCS-P, CPC, CCS or CPC-H coding certification. Associates Degree in Healthcare Administration or Business Administration.
PREFERRED CERTIFICATION:
Facility or Profee Certification
QUALIFICATIONS:
Four+ years experience in professional production coding, billing and reimbursement and/or related education. Experience in a clinic setting Coding specialization. Extensive knowledge of medical terminology, medical coding (e.g. CPT-4 & ICD-9-CM), and state, federal, and Medicare regulations. Strong written and verbal communication skills with emphasis on relationship building and communicating effectively with a group. Understanding of coding req for Lab/Radiology services commonly performed in a medical center environment. Pass an internal proficiency assessment, for professional coding, with a score of 90% or higher. Able to work independently and meet deadlines. Accept roles with increasing responsibility. Basic knowledge of Kaiser Revenue Cycle for the purpose of communicating corrective action recommendations. Working knowledge of Microsoft Office (Word, Excel, Access and Powerpoint). Must be able to work in a Labor/Management Partnership environment.
PREFERRED QUALIFICATIONS:
Bachelors Degree in Healthcare Administration or Business Administration. Completion of approved AHIMA/AAPC Coding Course. Experience in a managed care environment. Professional Coding Credential of CPC or CCS-P, Four years minimum coding experience in a facility setting
SKILLS TESTING: Coding Assessment provided by the hiring department
DUTIES:
Review/analysis of coding (ICD-9, CPT 4, DRG, Revenue and HCPCS) and medical documentation associated with Inpatient Hospital encounters for accuracy and regulatory compliance. Review/analysis of revenue cycle data using the Kaiser Permanente Billing Gold Standard. Analysis of any data changes affected by system interfaces. Analysis of data changes affected by back-end revenue cycle activities. Capture and report findings in an excel spreadsheet or access database. Provide feedback and assist during the Corrective Action Process. Provide coding assistance and feedback to ensure appropriate reimbursement, as well as to ensure that coding and documentation meet regulatory requirements.
Maintain current knowledge of coding conventions, changes and regulations related to professional and facility coding for Inpatient services. Must be able to work independently, meeting all scheduled deadlines.
Consistently supports compliance and the Principles of Responsibility (KP’s code of conduct) by maintaining confidentiality, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable Federal and State laws and regulations, accreditation and licensure requirements, and KP policies and procedures.
In addition to defined technical requirements, accountable for consistently demonstrating service behaviors and principles defined by the Kaiser Permanente Service Quality Credo, the KP Mission as well as specific departmental/organizational initiatives. Also accountable for consistently demonstrating the knowledge, skills, abilities, and behaviors necessary to provide superior and culturally sensitive service to each other, to our members, and to purchasers, contracted providers and vendors.
- Kaiser Permanente is an AA/EEO employer -
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