Description

Job Summary:

Ensures all technical aspects of the assignment of diagnostic and procedure coding is carried out in accordance with established standards and is in compliance with CMS, NCQA, other regulatory agencies, third party payers and Kaiser Permanente policy. Function includes, but is not limited to working charge review work queues, other forms of charge submissions and querying providers to ensure the completeness and accuracy of coding of internal services performed.

Essential Responsibilities:

• Responsible for reviewing primarily medical and ancillary type workques charge sessions within KP Health connect and applying coding principles for correct coding.
• Research, code, and/or data enter encounters that are supported by KPHC with the Charge capture tool.
• Review all other charge sessions submitted via paper encounters, physician in baskets and other various methods to ensure correct coding principles have been applied.
• Query providers for clarification of incomplete or ambiguous documentation as appropriate and monitor in basket messages for timely responses.
• Evaluates and identifies front end and back end error trends for training needs and brings them to the attention of the supervisor.
• Communicates and Participates in departmental meetings and initiatives involving Coding and the Revenue Cycle Enhancement process.
• Performs other duties as assigned or required.

Basic Qualifications:

Experience

• One (1) year of experience in a healthcare setting with proficiency in medical terminology is required.
• One (1) year of customer service experience is required.
• Per the National Agreement, current KP Coalition employees have this experience requirement waived.

Education

• Completion of coursework that includes anatomy & physiology, pathophysiology, pharmacology, medical terminology, reimbursement methodology, intermediate/advanced ICD diagnostic/procedural and CPT coding.
• High School Diploma or General Education Development (GED) required.

License, Certification, Registration

• Certified Professional Coder OR Certified Coding Specialist - Physician Based

Additional Requirements:

• New Hire: Successful completion of Assessment of Critical Coding Skills and 80% or higher passing score.
• Annually: Successful completion of Assessment of Critical Coding Skills and 80% or higher passing score.
• Ability to work with and maintain confidentiality of physician, patient, patient account and personnel data is required.
• Effective verbal and written communication skills, as well as, strong interpersonal skills is required.
• Ability to effectively abstract medical information to determine the correct data is required.
• Must be able to work in a Labor/Management Partnership environment.

Preferred Qualifications:

• Knowledge of coding practices is preferred.
• Knowledge of compliance and regulatory requirements is preferred.
• Strong data management skills including proficiency in MS Office applications is preferred.

Primary Location: Maryland,Hyattsville,New Carrollton Administration
Scheduled Weekly Hours: 40
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri
Working Hours Start: 08:30 AM
Working Hours End: 05:00 PM
Job Schedule: Full-time
Job Type: Standard Worker Location: Remote
Employee Status: Regular
Employee Group/Union Affiliation: M40|OPEIU|Local 2
Job Level: Individual Contributor
Department: New Carrolltn Admin - HealthInforMgmt Administratn - 1808
Pay Range: $32.07 - $46.17 / hour Travel: No Remote: Work location is the remote workplace (from home) within KP authorized states. Worker location must align with Kaiser Permanente's Authorized States policy. Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.
Requisition #: 1394426

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