Manager, Clinical Documentation and Reporting Support

Kaiser Permanente    Oakland, CA
Job Description

The Permanente Federation LLC (the Federation) is the national leadership and consulting organization for the eight Permanente Medical Groups (PMGs), which, together with the Kaiser Foundation Health Plans (KFHP) and Kaiser Foundation Hospitals (KFH), comprise Kaiser Permanente. The PMGs employ almost 23,000 physicians, approximately 90,000 nurses, other clinicians and staff, and provide care to over 12.2 million Kaiser Permanente members. The Federation works on behalf of the PMGs to optimize care delivery and advance Permanente Medicine - medicine that is patient centered, evidence based, technology enabled, culturally responsive, team delivered, and physician led. The Federation, based in Oakland, California, is dedicated to serving and leading Permanente Medicine, the Permanente Medical Groups, and Kaiser Permanente in support of our patients and members.

The incumbent is responsible for working collaboratively with Kaiser Permanente documentation and coding leaders and their teams to provide consult and support in meeting PMG specific and enterprise wide goals related to clinical documentation, coding, and risk adjusted claim submission.

Individual will have accountability in functional areas including: compliance, monitoring, data mining, risk adjustment, charge capture, clinician and coder training.

Essential Responsibilities:
  • Partner with TPF and PMG leaders and their teams in producing a more coordinated Risk Adjustment Operations program. This will include helping to define and tactical objectives for documentation and reporting initiatives and tracking performance against those objectives with key stakeholders.
  • Work with the Clinical Documentation Reporting Group and subgroups to develop targeted physician/clinician education programs as it pertains to clinical documentation and reporting.
  • Partner with KP HealthConnect (KPHC) leaders to ensure that accurate and complete information regarding services provided and health conditions managed by clinicians are extracted and transmitted to payers, regulators, and other parties compliantly.
  • Partner with Convergent Medical Terminology (CMT) to guarantee that EDG display names and mapped ICD-10-CM codes are accurate and clinically relevant.
  • Work with Executive Director for Documentation, Coding and Reporting and National Compliance Office (NCO) to advocate for improvements in code sets and guidelines for improved use within our systems in support of current clinical practice.
  • Develop and maintain an expert level of knowledge of risk-based reimbursement methodologies.
  • Collaborate with the KP National Compliance Office (NCO), National Revenue Cycle Integrity (NRCI), the CDRG, and KPHC to resolve issues or questions regarding code application, including documentation requirements.
  • Promulgate agreed upon advice, guidance and standards to all stakeholders as a subject matter expert consultant to the CDRG.
  • Provide PMG guidance regarding audit scope, design, execution, analysis and response.

Basic Qualifications:
  • Minimum ten (10) years of experience with documentation and coding physician training.
  • Minimum ten (10) years of experience with clinical medical record auditing.
  • Minimum five (5) years of project management or management experience.
  • N/A.
License, Certification, Registration
  • AHIMA CCS-P, AAPC CRC or AAPC CPC coding certification required.

Additional Requirements:
  • Ability to interpret and apply Federal and State regulations, coding, and billing requirements.
  • Demonstrated experience in both CMS National and Contract Level and HHS RADV audits.
  • Knowledge of SNOMED CT.
  • Required knowledge of compliance and regulatory requirements for all reimbursement models for inpatient and outpatient documentation and coding.
  • Demonstrated ability to understand analytical data to identify documentation and coding trends and other risk areas.
  • Demonstrated ability to communicate findings to physician and noon-physician business partners and develop appropriate action plans based on audit results.
  • Demonstrated ability to lead a large, cross-functional and diverse resource team.
  • Maintains knowledge of industry standards and technology solutions for risk adjustment.

Preferred Qualifications:
  • Ten (10) years of health care and electronic health records experience
  • Bachelor-s degree in Business Administration, Finance, HIM, or related field preferred.
  • Ability to work with and maintain confidentiality of physician, patient, patient account and personal data

PrimaryLocation : California,Oakland,Ordway One Kaiser Plaza
HoursPerWeek : 40
Shift : Day
Workdays : Mon-Fri
WorkingHoursStart : 8:30 AM
WorkingHoursEnd : 5:00 PM
Job Schedule : Full-time
Job Type : Standard
Employee Status : Regular
Employee Group/Union Affiliation : Salaried, Non-Union, Exempt
Job Level : Manager with Direct Reports
Job Category : External Affairs / Relations
Department : Finance
Travel : Yes, 25 % of the Time
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

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 and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.

Sun, 10 Nov 2019 01:11:17 GMT

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