Certified Professional Coder 4 - (Flexible in MD/DC/VA)

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, third party payors, other regulatory agencies and Kaiser Permanente policy.  Functions includes, but are not limited to working charge review work queues for reimbursable accounts for all internal and external surgical services. Serves as a technical coder for all specialties. Assists supervisor in responding to coding questions from other levels of coders and in responding to providers. Conducts special projects and focused reviews of encounters as requested.

• Required to research and assign. HCPCS Level II codes for ambulatory surgical services and/or professional services performed. Ability to research, analyze and/or review detailed and high complexity code edits and transactions within the Kaiser Permanente system.


• Provides additional support to the coding staff by resolving complex cases and issues.


• Contributes to the development and maintenance of specialty specific education materials.


• Maintains current knowledge of coding conventions, guidelines, updates, and regulations governing government and third party billing to ensure that Kaiser Permanente Colorado coding and documentation meets regulatory guidelines and audit standards, and results in appropriate reimbursement.


• Must meet and maintain departmental Coding quality measures and production standards.


• Collaborates with clinical and non-clinical groups, to develop, implement and communicate specific coding and documentation guidelines that will fulfill the internal needs for complete and consistent clinical data.


• Serves as coding expert on various committees as requested.


• Supports compliance and Kaiser Permanentes Code of Conduct by adhering to federal and state laws and regulations, accreditation and license requirements, by policies and procedures. Responds appropriately to observed fraud and abuse.

Qualifications:

• Minimum five (5) years of experience in a healthcare setting with proficiency in medical terminology is required.


• Minimum four (4) years of coding experience is required.


• Minimum four (4) years of customer service experience is required.


• Minimum four (4) years of knowledge in coding practices is required.


• Minimum four (4) years of knowledge of compliance and regulatory requirements is required.

• Associates degree in health administration, RHIT certification OR two (2) years of experience in a directly related field.
• High school diploma OR General Education Development (GED) is required.

• Certified Professional Coder OR Certified Coding Specialist - Physician Based

• Certified Coding Specialist within 6 months of hire
  

• New Hire: 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.
• Ability to work independently with minimal supervision is required.

• Project management experience preferred.
• Training/Education experience preferred.
• Supervisory experience preferred.
• Strong data management skills including proficiency in MS Office applications is preferred.
• Ability to abstract and assign all codes to surgical procedures performed.
• Must be able to work with a variety of healthcare professionals at all levels.
• Ability to communicate with physicians and non-physician staff with a commitment to provide quality customer service.
• Working knowledge of medical specialties, including clinical conditions seen and procedures performed.