Coding Compliance Auditor - Maui Health

Job Summary:

HIM Coding auditor/trainer will coordinate, monitor, and audit documentation and coding of inpatient and/or outpatient services in all applicable health care settings. Audits will focus on correct assignment of CPT, ICD-10, ICD-9- CM, HCPSC codes and clinician documentation to ensure that Kaiser Permanente is compliant with all regulatory guidelines and internal controls. Audits will encompass internal practitioners, contracted practitioners, coders, internal facilities and contracted facilities. The auditor will analyze audit results, identify patterns, trends or variations in coding and documentation practices and make recommendations for improvement. When necessary, this position will initiate corrective action plan to ensure resolution of problem areas identified during auditing and monitoring activity. This position will serve as a liaison with HIM staff, Revenue Cycle, External and Internal practitioners, and other regional departments as appropriate including but not limited to IT, benefits, etc. Essential Responsibilities:

Reviews and audits coders based on federal regulatory requirements [e.g. the Centers for Medicare and Medicaid Services (CMS)] and current documentation and coding guidelines, as well as ensuring compliance with departmental/internal policies and other applicable laws and regulations.

Prepare written audit report for all noted deficiencies and make recommendations to Coding and Revenue Cycle Compliance Manager, HIM director and others as appropriated/requested (i.e. training, oversight, monitoring, process flows, etc.). Conducts trend analyses to identify patterns and variations in coding practices and case-mix index.

Develop and deliver education and training programs related to results of document and coding reviews, and findings from RAC and other regulatory audits.

Compares coding and reimbursement profile with regional and national norms. Reviews coding claim denials and rejections.

Receives and investigates reports of compliance violations. Communicates results to HIM director and compliance officer. Ensures appropriate dissemination and communication of all regulation, policy, and guideline changes to affected personnel.