Specialist III, Coding Quality

Description:
With limited supervision, coordinates and conducts validation review, assessment and applies appropriate query and/or modification to practitioner submitted medical code assignments. Participates in trend identification and analysis on an ongoing basis, regarding TSPMG practitioners, and additional clinical areas as requested, utilizing established documentation and coding criteria. These include but are not limited to; application of documentation standards; validation of health record completeness; process studies and verification; state and federal regulatory, accrediting audits, coding compliance and documentation analysis and validation; etc. Concurrent analysis of coding of Kaiser Permanente commercially billable encounters and procedures, providing coding selection support through professional interpretation of AHA, AMA, and CMS guidelines. Uses professional judgment and applies internal policy and procedure standards to complete query / communication with practitioners. Performs validations and prepares queries for practitioners on their medical service / clinical documentations and code assignments to ensure that KPSE (Georgia) receives appropriate reimbursement while conforming to all applicable guidelines, regulations, and standards (Federal, State, and internal). Travel required less than 10%. Candidates must be committed to maintaining the highest quality and production standards.

• Data / documentation and coding validation and analysis. Authorized to modify assigned codes based on clinical documentation review, coding guidelines and queries / issues requiring clarification by clinician.


• Participates with some supervision in test environments as UAT candidates (user acceptance testing). Document and present analysis to leadership on a project basis. Supports specialty-specific training to practitioners on documentation of services, appropriate coding of level of service, diagnosis and procedures code assignments through interpretation of appropriate coding guidelines. Supports training at the department, team, or individual level as needed.


• 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.