• Documentation and Coding Lead

    Region
    Portland Metro Area
    Full/Part Time
    Full Time
    Req ID
    4074
  • Overview

    Northwest Permanente, P.C. (NWP) is a self-governed, physician led, multi-specialty group of over 1500 physicians, surgeons, and clinicians, caring for over 600,000 members in Oregon and Southwest Washington. NWP is seeking a Document and Coding Lead to oversee Coding Educators and Educator Apprentices to ensure that KPNW receives appropriate reimbursement and follows industry standards and guidelines. This position will serve as an expert to Coding Educators, Coding Educator Apprentices. 

     

    Major Responsibilities/Essential Functions:

    • Oversees the accurate, complete, and timely reviews and validations of professional services delivered by KPNW clinicians.
    • Develops and conducts a program of ongoing internal quality reviews; and communicates review program results to the Coding Educator and the Coding Apprentice teams using education and training as needed individually or collectively to ensure coding consistency and accuracy is maintained.
    • Communicates review program results with busy clinicians and tactfully persuades them to change documentation and/or coding practices which may be inadequate from an organizational viewpoint. (While this is of critical importance to the business of the organization, it may be of low priority to clinicians whose appropriate focus is on the immediate demands of patient care.)
    • Evaluates and draws appropriate conclusions from coding guidelines and translates these industry standards into routine educator work processes to maintain proper code capture with documentation of professional services.
    • Ensures professional service compliance without adversely impacting the advantages of an integrated system as well as stand-alone service delivery and non-integrated medical record and billing systems.
    • Acts as a lead and mentor to the Coding Educator and the Coding Apprentice teams to serve as a resource liaison to the review and training functions of DCS and KP HealthConnect.
    • Identifies and recommends workable solutions to system or operational problems.
    • Provides/assist clinician training on documentation and coding, including tips and techniques to help clinicians do this correctly and efficiently in KP Health Connect.
    • Analyzes workflow problems and assists with KPIT and business process leads to resolve system workflow problems to ensure correct coding and billing of services using KP HealthConnect. (Systems and workflow may be different for KP vs. contract hospital service delivery.  Persuade parties, including physicians, to make workflow and/or system changes to reduce the volume of errors routed to the coding error queue.)
    • Develops and manages team work plans and staffing to ensure efficient accomplishment of accountabilities and objectives.
    • Recruit, develop, appraise and retain competent, professional coding staff.
    • Performs periodic quality reviews of documentation and coding in KP HealthConnect.
    • Analyze provider review results and provides summary feedback to individual clinicians, making recommendations for improvement.
    • Creates and maintain tools to review service data.
    • Works with contract hospitals and contract staff to resolve any issues pertaining to the identification of patients treated by NWP physicians and timely access to relevant documentation. (These issues are often contentious and sometimes lost in the myriad of issues in the delicate relationship with our contract hospitals.)

    Minimum Education & Work Experience:

    • Associate’s degree Health Information Management, or equivalent education or experience that is directly related to the duties and responsibilities.
    • Five (5) years’ progressive outpatient multispecialty coding experience in professional services including Medicare.
    • One (1) year previous experience that includes conducting coaching/training of coding staff.
    • One (1) year experience evaluating coding reviews and quality performance.
    • Three (3) years’ as a Coding Educator or equivalent experience in coding and documentation of outpatient professional services. 

    Additional Requirements:

    • Excellent command of the ICD-10-CM and CPT-4, and prior knowledge of ICD-9-CM classification systems with thorough understanding of the effect of data quality on prospective payment, utilization, and reimbursement for multiple medical professional service specialties.
    • Thorough working knowledge of hospital/institutional coding in multiple medical specialties, and Thorough understanding data systems and reporting for health record coding, abstracting, and performance metrics.
    • Advanced understanding of medical terminology, pharmacology, body systems/anatomy, physiology and concepts of disease processes and the link to proper assignment of clinical conditions documented and procedures performed.
    • Proficient and in-depth knowledge of ICD-10-CM, ICD-9-CM, CPT and HCPCS and Evaluation and Management coding guidelines.
    • Exemplary 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.
    • Extensive computer experience and ability to learn new computer applications quickly and independently, including: EMR(s), Microsoft Office Suite and other software programs.
    • Ability to independently manage a significant work-load, and to work efficiently under pressure meeting established deadlines.
    • Excellent ability to conduct coding reviews to evaluate quality performance measures and using the findings create written reports with recommendations; and then present education and feedback to facilitate improvement of documentation and coding.
    • Excellent interpersonal communication skills (written and verbal) to deal effectively in delicate, sensitive and/or complex situations.
    • Excellent time management and project management skills.
    • Excellent presentation skills to provide training and education to small or large groups.
    • Abides by the Standards of Ethical Coding as set forth by AHIMA and AAPC.
    • Meets department standards for performance and quality - Maintains a 98% accuracy rate; failure to do so would cause a drop-in job level.
    • Final candidate will be required to obtain 75% or better on Kaiser Coding Skills Assessment test.
    • Currently credentialed as a Registered Health Information Administrator (RHIA), or a Registered Health Information Technician (RHIT), Certified Coding Specialist Professional (CCS-P) from AHIMA, or Certified Professional Coder (CPC) from AAPC.

    Preferred Education & Qualifications

    • Bachelor’s degree in Health Information Management
    • Five (5) years’ progressive outpatient multispecialty coding experience in professional services including Medicare.
    • Two (2) years’ previous experience that includes conducting coaching/training of coding staff.
    • Two (2) years’ experience evaluating coding audits and quality performance.
    • Working knowledge of KP HealthConnect, particularly the clinical and billing modules, encoder(s) (i.e. 3M or Encoder Pro), Microsoft Office Suite and other software products.

    At Northwest Permanente, P.C., 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, P.C. believes that diversity, inclusion, and equity among our employees is critical to our success and we seek to recruit, develop and retain the most talented people from a diverse candidate pool.

    Responsibilities

     

     

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