Kaiser Permanente-posted 3 months ago
Mid Level
Pasadena, CA
Ambulatory Health Care Services

This position is flexible and must be based in a KP location, CA, OR, CO, WA, GA, MD, VA, HI or D.C. The position is responsible for serving as a compliance subject matter expert related to coding functions within all settings of care, maintaining compliance with national coding policies and procedures, assisting with coding questions and related topics, and auditing all lines of business for coding. Additionally, this position is responsible for assisting with the development of audit result reports to regional staff and senior management and supporting compliance and the Principles of Responsibility (KPs code of conduct).

  • Practices self-development and promotes learning in others by proactively providing information, resources, advice, and expertise with coworkers and customers.
  • Completes work assignments and supports business-specific projects by applying expertise in subject area; supporting the development of work plans to meet business priorities and deadlines.
  • Ensures team follows all procedures and policies; coordinating resources to accomplish priorities and deadlines.
  • Collaborates cross-functionally to make effective business decisions; solving complex problems; escalating high priority issues or risks as appropriate.
  • Conducts company compliance activities by collaborating with internal and external stakeholders; applying established regulations and standards to compliance efforts.
  • Develops compliance reports by evaluating and summarizing compliance data, audit information, and potential risks and remedies.
  • Conducts compliance investigations by collecting and analyzing quantitative and qualitative data; conducting interviews as appropriate; researching key business issues.
  • Assists with and supports the management of projects or compliance components of larger cross-functional projects by coordinating stakeholder contacts.
  • Assists with ensuring regulatory compliance by monitoring regulatory changes; conducting analysis on regulatory impacts.
  • Coordinates the implementation of compliance efforts by identifying compliance requirements; assessing the current state of compliance to identify gaps and corrective actions.
  • Minimum four (4) years medical coding experience.
  • Bachelor's degree in Health Care Administration, Clinical, Law, Public Health, Business or related field.
  • Minimum six (6) years experience in health care compliance, health care operations (quality, risk, etc.), audit, finance, regulatory or public policy development, investigations, information security, or insurance/health plan governance or a directly related field.
  • Certified Coding Specialist from American Health Information Management Association OR Certified Professional Coder from American Academy of Professional Coders.
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