Specialist II, Professional Coder

Description:
With minimal supervision, coordinates and conducts code assignments and validation for KFHP professional services and procedures.  Utilizes established documentation and coding criteria based on the National Cooperating Party Guidelines and Standards.  Responsible for concurrent analysis of coding for all professional evaluation/managementand procedural encounters and provides coding assistance through interpretation of guidelines and query/communication to practitioner.  Performs coding assignment and validations and prepares queries for practitioners on their medical service for all practice locations (all Medical Office Buildings). Ensures the organization submits compliant, accurate, and complete clinical encounters for appropriate reimbursement.  Conforms to applicable guidelines and regulations (Federal, State, and Internal) and Serves as a liaison with TSPMG staff, NMF, external and internal practitioners, and other regional departments as appropriate including but not limited to IT, benefits, etc.

• Assign appropriate E&M, diagnosis, and procedure codes following coding guidelines for the most current version of ICD-CM, CPT, and HCPCS Level II for patient encounters.


• Provide expert consultation to other KPSE (Georgia) staff seeking coding advice.


• Provide consultation to any KP MD  as assigned on all coding and documentation questions. Within assigned clinical specialties, maintain current knowledge to ensure that KPSE (Georgia) coding and documentation meets regulatory guidelines and audit standards, and results in appropriate reimbursement.


• Maintains up-to-date knowledge regarding professional health information practices, as well as standards and regulatory requirements related to health information management and coding compliance (Federal, State, internal).


• Supports team members who participate in task force groups regarding health information and coding issues.


• Ability to accurately assess complex specialty code assignment and submissions including but not limited to General Surgery, Plastic Surgery, Gastroenterology, OB/Gyn, Urology, Orthopedics, Nephrology, ENT, Ophthalmology Minimum accuracy rate of 90%. Team is audited monthly 10 encounters per coder.


• Identify, report, and resolve issues through partnership with clinicians, department administration, and other coding staff to reduce denials and improve time to submission.


• Achieves and maintains departmental productivity standards.


• Maintaining objectivity and professional credibility overall.


• Consistently supports compliance and the Principles of Responsibility (Kaiser Permanentes Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state and local laws and regulations, accreditation and licenser requirements (if applicable), and Kaiser Permanentes policies and procedures.


• Your access to protected health information (PHI) will be limited to the minimum necessary required to effectively perform your job.


• In addition to defined technical requirements, you will be accountable for consistently demonstrating service behaviors and principles defined by the Kaiser Permanente Service Quality Credo, the KP Promise, and specific departmental/organizational initiatives. You also will be accountable to consistently demonstrate 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.


• Maintenance and fulfillment of all required CEUs to maintain credentials through AHIMA or AAPC is required.


• Maintains appropriate coding certifications as outlined in educational and certification requirements.


• Partners with TSPMG Documentation and Coding department to coordinate accurate documentation and coding information.


• Will assure compliance with applicable federal, state and local laws and regulations, The Principles of Responsibility, the Code of Conduct for KP, internal policies and procedures, professional standards and accreditation standards.


• May perform other duties as assigned.