Clinical Education Consultant

Kaiser Permanente - Redwood City, CA

Full-time - Mid Level

Redwood City, CA

Ambulatory Health Care Services

About the position

The position is responsible for developing and delivering training programs focused on coding and documentation improvement, ensuring compliance with regulatory requirements. The role includes supervising Data Quality Auditors, conducting audits, and providing expertise on coding guidelines. The individual will work closely with local teams to enhance data capture and accuracy, while also mentoring entry-level trainers and managing local coding initiatives.

Responsibilities

• Develops training programs that support coding and documentation improvement and address documentation risk areas identified through local and regional audits.
• Provides high quality training with minimal support to improve encounter data capture and coding and documentation accuracy.
• Serves as the expert in supporting the local Coding and Documentation team to meet local objectives and achieve performance goals.
• Participates in various local committees, eg CDI, ROG, PCM, etc.
• Supports the local Coding and Documentation team to address operational processes that hinder encounter data capture.
• Supervises Data Quality Auditors to ensure audits and remediation are performed accurately and timely, and in accordance with regional compliance and Federal and State requirements.
• Reviews audit plan, monitors audit schedules, and auditor accuracy and productivity.
• Assures audit results are entered into regional audit database to support quality assurance process, regional analysis and regional training activities.
• Prepares medical center auditing analysis to determine root causes of under or over reporting as well as quantifying the effect of the condition identified in the audit.
• Recommends appropriate actions and ensures completion.
• Partners with EIO Training to develop training materials to address audit trends and risk areas identified based on audit findings and data analysis.
• Provides expertise to Medical Center leadership and Coding and Documentation team on internal and external regulatory requirements (eg, CMS, NCQA).
• Works with medical center leadership to provide confidential audits and feedback on an as needed basis.
• Communicates changes to federal and state government billing and coding guidelines to medical center leadership, local Coding and Documentation team, and links the messages between region and the medical center.
• Conducts both Medicare and E/M audits on an as-needed basis.
• Assures corrective actions are implemented for audit review findings.
• Assists in developing and implementing policies and procedures/Compliance Audit Standards to ensure compliance with Federal, State and other regulatory requirements and assures local compliance with these policies and procedures.
• Mentors and coaches entry level trainers as appropriate.
• Provides project management support for local coding and documentation initiatives.

Requirements

• Minimum seven (7) years of experience in developing programs and conducting training for diverse audiences with minimal supervision.
• Minimum seven (7) years of coding experience based on Coding Clinic Guidelines for inpatient and outpatient.
• Minimum seven (7) years of experience conducting E/M and Medicare audits.
• Bachelors degree in business administration, health care, public health, finance, business medical records technology OR four (4) years of experience in a directly related field.
• High School Diploma or General Education Development (GED) required.
• Registered Health Information Technician Certificate OR Registered Health Information Administrator Certificate OR Professional Coder Certificate OR Certified Coding Specialist.

Nice-to-haves

• Experience using PC applications such as MS Word, Excel, Access, PowerPoint.
• Medical center operations or clinical experience.
• Masters degree in business administration, health care, public health, finance, business medical records technology OR six (6) years of experience in a directly related field.

Benefits

• Sign On Bonus Eligible