Manager, Coding Quality Review

Job Summary:

Manages coding quality audits by training and coordinating team members on best practices in conducting special projects, audits, reviews, and/or monitoring. Manages audit analysis and report writing by leading team members in implementing new strategies in comparing coding and documentation across the enterprise to identify potential risks and remedies, and sharing pattern and trend analysis summary reports at the market level that identify opportunities found within reports/reviews. Manages enhancements to coding integrity by overseeing the implementation and evaluation of new departmental processes and workflows to ensure their effectiveness at addressing all noted opportunities, and resolving identified issues at the market level. Manages compliance by providing guidance to team members interpreting national, state, and KP-specific coding, billing, and documentation guidelines/guidance for KPs leadership, attorneys, physicians, coders, compliance, and billers to ensure consistent and accurate implementation and compliance with external regulations.

Essential Responsibilities:

• Provides developmental opportunities for others; builds collaborative, cross-functional relationships. Solicits and acts on performance feedback; works closely with employees to set goals and provide open feedback and coaching to drive performance improvement. Pursues professional growth; develops and provides training and development to talent for growth opportunities; supports execution of performance management guidelines and expectations. Leads, adapts, implements, and stays up to date with organizational change, challenges, feedback, best practices, processes, and industry trends. Fosters open dialogue amongst team members, engages, motivates, and promotes collaboration within and across teams. Delegates tasks and decisions as appropriate; provides appropriate support, guidance, and scope; encourages development and consideration of options in decision making.

• Manages designated work unit or team by translating business plans into tactical action items; oversees the completion of work assignments and identifies opportunities for improvement; ensures all policies and procedures are followed. Aligns team efforts; builds accountability for and measuring progress in achieving results; determines and ensures processes and methodologies are implemented; resolves escalated issues as appropriate; sets standards and measures progress. Fosters the development of work plans to meet business priorities and deadlines; obtains and distributes resources. Removes obstacles that impact performance; identifies and addresses improvement opportunities; guides performance and develops contingency plans accordingly; influences teams to execute in alignment with operational objectives.

• Manages audit analysis and report writing by: leading team members in implementing new strategies in comparing coding and documentation across the enterprise to identify potential risks and remedies; validating trend analyses to identify patterns and variations at the market level in coding practices, key compliance drivers, liabilities, and performance indicators (e.g., adherence to standards, incorporation of new regulations), and sharing feedback with team members as needed; and sharing pattern and trend analysis summary reports at the market level that identify opportunities found within reports/reviews.

• Manages coding quality audits by: overseeing and evaluating the auditing program for coding compliance to assess accuracy of all code assignments and adequacy of documentation to support the codes chosen; training and coordinating team members on best practices in conducting special projects, audits, reviews, and/or monitoring; assessing the effectiveness and ease of use of processes, and revising as necessary; and ensuring that all special projects, audits, reviews, and/or monitoring align with state and federal regulatory and reimbursement requirements, current documentation, and coding guidelines.

• Manages compliance by: providing guidance to team members interpreting national, state, and KP-specific coding, billing, and documentation guidelines/guidance for KPs leadership, attorneys, physicians, coders, compliance, and billers to ensure consistent and accurate implementation and compliance with external regulations; empowering staff to attend national committees; and planning and removing barriers to allow others to attend National Compliance programs to assure maximum utilization of coding resources when conducting special projects, monitoring, reviews, and/or audits.

• Manages enhancements to coding integrity by: coaching and monitoring team members who are assisting with the identification of coding/documentation trends and opportunities; overseeing the implementation and evaluation of new departmental processes and workflows to ensure their effectiveness at addressing all noted opportunities, and resolving identified issues at the market level; and managing improvements for communicating up-to-date and accurate regulation, policy, and guideline changes impacting coding and documentation for all impacted employees, and monitoring for adherence at the market level.

Knowledge, Skills and Abilities: (Core)

• Ambiguity/Uncertainty Management

• Attention to Detail

• Business Knowledge

• Communication

• Constructive Feedback

• Critical Thinking

• Cross-Group Collaboration

• Decision Making

• Dependability

• Diversity, Equity, and Inclusion Support

• Drives Results

• Facilitation Skills

• Health Care Industry

• Influencing Others

• Integrity

• Leadership

• Learning Agility

• Organizational Savvy

• Problem Solving

• Short- and Long-term Learning & Recall

• Strategic Thinking

• Team Building

• Teamwork

• Topic-Specific Communication

Knowledge, Skills and Abilities: (Functional)

• Audits

• Compliance Management

• Data Quality

• Execution Excellence

• Health Care Compliance

• Health Care Data Analytics

• Health Information Systems

• Information Gathering

• Internal Audit Processes

• Maintain Files and Records

• Medical Coding

• Medical Terminology

• Quality Assurance and Effectiveness

• Quality Improvement

• Stakeholder Management

• Technical Documentation

• Training

• Trend Analysis

• Written Communication

Minimum Qualifications:

• Minimum two (2) years of experience in International Classification of Diseases (ICD)-10-Clinical Modification, Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) coding, including chart auditing, applying diagnoses and/or procedure codes, and/or conducting coding reviews.

• Minimum three (3) years of experience in a leadership role with or without direct reports.

• Bachelors degree in Business Administration, Health Information Management, Health Care Administration, Health/Health Care Informatics, or related field AND minimum four (4) years of experience in health care compliance, health care operations (quality, risk), audit, insurance/health plan governance, coding, medical record review, or a directly related field OR Minimum seven (7) years of experience in health care compliance, health care operations (quality, risk), audit, insurance/health plan governance, coding, medical record review, or a directly related field.

• Certified Coding Specialist required at hire OR Registered Health Information Administrator required at hire OR Registered Health Information Technician required at hire OR Certified Coding Specialist - Physician Based required at hire OR Certified Professional Coder required at hire

Preferred Qualifications:

• Risk Adjustment Certification.

• Three (3) years of auditing experience.

COMPANY: KAISER

TITLE: Manager, Coding Quality Review

LOCATION: Santa Clara, California

REQNUMBER: 1456959

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.