Analyst Medicare/Medicaid Coding - Kaiser Permanente

Apply in depth knowledge of Medicare/Medicaid coding guidelines, NCD/LCD, CMS Regulations, to analyze and review coding for compliance, medical necessity, and/or any other coding/billing specific reasons. Review medical record documentation to ensure services are coded/billed with appropriate diagnoses and services. Applies in depth knowledge of industry standard coding and billing rules to correct errors and resolve problems related to preparing and submitting accurate medical bills for services provided in Hospitals, ASCs, Outpatient, Extended Care Facilities and Pharmacy settings. Analyze and gather coding trends to present to Management and Health Information Management (HIM). Monitor system issues as related to coding/billing, i.e., interfaces, charge master, electronic claims submission, etc. Follows up on denials for coding and files appeals as appropriate. Resource for HIM for issues identified as needing detailed high level coding review. Source of education/knowledge for Patient Financial services (PFS) when issues require higher knowledge base of coding, compliance and industry standards. Essential Responsibilities: + Focusing on Coding issues, applies in depth knowledge of industry standard coding and billing rules to correct errors and resolve problems related to preparing and submitting accurate bills for services provided in our Hospital, ASC and Outpatient, Extended Care Facilities and Pharmacy settings. Involving errors that have to do with ICD-9-CM/ICD-10 CM, CPT and HCPCS codes on the claims. + Review medical record documentation to ensure services are assigned appropriately. Apply in depth knowledge of Medicare/Medicaid coding/billing guidelines, NCD/LCD, CMS Regulations, to analyze and review coding for compliance, medical necessity, and/or any other coding/billing specific reasons. + Collaborate with various departments within DSBS for issues identified as needing ongoing and detailed high level coding review. Source of education/knowledge for Patient Financial services (PFS) and Customer Service department when issues require higher knowledge base of coding, compliance and industry standards + Applies in depth knowledge of industry standard coding and billing rules, to investigate and resolve issues related to outstanding insurance balances. + Conduct follow up on claim denials needing coding review. + Correct as appropriate to reflect services documented in the medical record in accordance to regulatory guidelines. + Ensure all services rendered have been coded/billed appropriately. Via phone, mail, and other correspondence methods, responds to internal and external customer coding issues. + Conduct appeals and adjustment requests as appropriate. + Analyze denial trends to provide recommendations to reduce claim denials and optimize reimbursement. + Identifies and communicates coding trends to present to Management and other departments within DSBS to develop recommendations for provider training and system inequities. + Responsible for identifying, participating in monitoring of existing and emerging coding/billing compliance risks. Identify trends over time and participate in root cause analysis for preventative measures. + Participate in ongoing process improvement work. Monitor system issues as related to coding/billing, i.e., interfaces, charge master, electronic claims submission, etc. + Communicate issues and areas of risk to appropriate departments and provide data when necessary Basic Qualifications: Experience + Minimum two (2) years of Medicare/Medicaid coding experience. Education + High School Diploma or General Education Development (GED) required. License, Certification, Registration + Professional Coder Certificate - Hospital required at hire OR Coding Specialist Certificate required at hire OR Coding Associate Certificate required at hire OR Coding Specialist Certificate - Physician Based required at hire OR Registered Health Information Technician Certificate required at hire OR Professional Coder Certificate required at hire OR Registered Health Information Administrator Certificate required at hire Additional Requirements: + Knowledge of payer specific billing regulations, including government programs, Medicare or Medicaid, CMS, HCFA, HCA. + Knowledge of HIPAA, WAC, RCW regulations. Preferred Qualifications: + Four (4) years of coding or billing; two years of which are billing with Medicare and Medicaid. + Coding/Billng vocational certificate. COMPANY: KAISER TITLE: Analyst Medicare/Medicaid Coding LOCATION: Spokane, Washington REQNUMBER: 1225507 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.