Manager, Risk Adjustment, Medical Coding

Kaiser Permanente • Pasadena, CA

82d

About The Position

The Manager, Risk Adjustment, Medical Coding position is responsible for serving as a compliance subject matter expert related to coding functions. This includes managing and directing audit activity related to coding within all settings of care, ensuring compliance with national coding policies and procedures, assisting with escalated coding questions, and developing and presenting coding educational inservices and seminars. The role also involves evaluating the quality of coding assignments across all lines of business, developing the annual coding audit plan in collaboration with reimbursement compliance teams, and reviewing reports of audit results. The manager will help set the direction for coding and focused projects related to audit outcomes, supporting compliance and the Principles of Responsibility (KP's code of conduct).

Requirements

• Minimum five (5) years medical coding experience.
• Minimum two (2) years experience in a leadership role with or without direct reports.
• 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, 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.

Responsibilities

• Serve as a compliance subject matter expert related to coding functions.
• Manage and direct audit activity related to coding within all settings of care.
• Ensure compliance with national coding policies and procedures.
• Assist with escalated coding questions and related topics.
• Develop and present coding educational inservices and seminars.
• Evaluate the quality of coding assignments across all lines of business.
• Develop the annual coding audit plan in collaboration with reimbursement compliance teams.
• Develop and review reports of audit results.
• Set the direction for coding and focused projects related to audit outcomes.
• Support compliance and the Principles of Responsibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Ambulatory Health Care Services
• Education Level: Bachelor's degree