Specialist Coding

Serve as a coding resource to staff throughout Kaiser Foundation Health Plan of Washington. Research coding issues regarding policies and guidelines from CMS and other payers. Provide coaching on coding issues and concepts. Evaluate medical record documentation against coding and billing compliance standards and provide written documentation of findings. Assist in maintenance, configuration and develop and implement coding improvement plans for Claim Editing System (iCES).

• Serves as the coding, documentation, reimbursement and compliance consultant to KFHPW healthpln staff. Demonstrates resource expertise on compliant coding and billing, and regulatory requirements. Researches clinical specialties, coding changes and guidelines, Federal and State health care billing rules and regulatory requirements, and industry-standard billing practices. Researches and responds to formal coding and provider reconsiderations resulting from Claim Editing System (iCES).


• Assists in medical record documentation audits of patient care against services and diagnoses reported by providers, following coding guidelines and policies. Provides written documenation of findings of the documentation audits to providers.


• Work with Coding Sr. Consult on reviews of the Claim Editing System (iCES) set-ups to assure that master files and tools are compliant with coding and billing rules. Makes recommendations on changes and enhancements to the Claim Editing System (iCES). Displays effective teamwork and leadership skills, setting and meeting deadlines and objectives for projects assigned; leads and participates in committees as requested; effectively collaborates with other departments throughout the organization.


• Identifies coding errors and process issues, provides feedback. Assists Coding Sr. Consultant before, during and after Claim Editing System (iCES) implementation changes. Assist Coding Sr Consultant in assuring compliance, assessing and providing appropriate education with respect to accurate and compliant coding in Claim Editing System (iCES). Evaluates medical record documentation against coding and billing standards and provides written documentation of findings.