Kaiser Permanente

Manages, coordinates and evaluates the activities of personnel engaged in Medicare Risk Adjustment audits and related projects.. Responsible for the continuous coordination and monitoring between multiple disciplines including: Coding, IT, Medicare Finance, PBS, CPMG and Operations.. Responsible for representing Colorado Medicare SOX Mega and for the identification and remediation of SOX related issues.. Participates in National and CMS driven Medicare Risk Adjustment audits and related projects (i.e., Benchmark, Probe audits).. Certified Coding Specialist from American Health Information Management Association OR Certified Professional Coder from American Academy of Professional Coders

coding manager

Description Salary Range: $50.67/hour-$59.57/hour Job Summary Manages and influences the complex Medicare Recovery process, related projects or programs with Regional and National resources. Manages, coordinates and evaluates the activities of personnel engaged in Medicare Risk Adjustment audits and related projects. Responsible for coordinating efforts with National and Regional CPMG, Revenue Cycle, Coding, and Medicare Finance leaders, with the goal of ensuring accurate and timely submissions to CMS. Maintains and optimizes the encounter data flow from end to end. Responsible for the continuous coordination and monitoring between multiple disciplines including: Coding, IT, Medicare Finance, PBS, CPMG and Operations. Provides recommendations and remediation of deficiencies. Responsible for the related changes in policies, training and configuration. Accountable for creating a culture of compliance, ethics and integrity. Maintains knowledge of and assures departmental compliance with Kaiser Permanentes Principles of Responsibility and policies and procedures, and applicable regulatory requirements and accreditation standards. Responds appropriately to observed fraud or abuse. Essential Responsibilities <ul><li>Ensures maximum Center for Medicare and Medicaid Services (a.k.a. CMS) compliance and reimbursement by coordinating multi-disciplinary departmental roles in the CMS data flow.</li><li>Responsible for representing Colorado Medicare SOX Mega and for the identification and remediation of SOX related issues.</li><li>Responsible for optimization of the alerts and reminders process.</li><li>Responsible for the optimization of the un-refreshed diagnosis process.</li><li>Manage the annual initiatives to capture un-refreshed diagnosis and data flow.</li><li>Participates in National and CMS driven Medicare Risk Adjustment audits and related projects (i.e., Benchmark, Probe audits).</li><li>Develops and coordinates, in conjunction with the Coding Department, CMS education for all clinical staff.</li><li>Responsible for monitoring yearly CMS changes related to ICD-9 codes.</li><li>Develops and maintains a compliant process to add and redact diagnoses captured from internal audits.</li><li>Investigates system configuration changes that will augment compliance and reimbursement.</li><li>Responsible for Part D RxHCC.</li><li>Supervises direct reports; including interviewing, selecting, training, motivating, evaluating, counseling, disciplining and terminating in compliance with EEO/AA goals and personnel policies of the organization.</li><li>Maintains current information and knowledge of all applicable Kaiser policies, local, state and federal laws and regulations, and accreditation standards. Ensures that the training activities incorporate all applicable KP policies, local, state and federal laws and regulations, and accreditation standards. </li></ul>Experience Basic Qualifications: <ul><li>Minimum three (3) years of project management experience.</li><li>Minimum two (2) years of coding experience required.</li><li>Minimum two (2) years of supervisory/leadership experience required. </li></ul>Education <ul><li>Bachelors degree in business, health care management, or clinical OR four (4) years of experience in a directly related field.</li><li>High School Diploma or General Education Development (GED) required. </li></ul>License, Certification, Registration <ul><li>Certified Coding Specialist from American Health Information Management Association OR Certified Professional Coder from American Academy of Professional Coders </li></ul>Additional Requirements <ul><li>Exceptional communication, influencing and partnering skills at all organizational levels.</li><li>Extensive knowledge of health care issues and the health care industry.</li><li>Knowledge of health care coding and billing systems a plus. </li></ul>Preferred Qualifications <ul><li>Minimum three (3) years of project management experience in health care, which included management of large-scope, complex projects preferred.</li><li>Masters degree preferred. </li></ul>Primary Location: Colorado,Denver,Northfield Support Services Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 08:00 AM Working Hours End: 05:00 PM Job Schedule: Full-time Job Type: Standard Worker Location: Remote Employee Status: Regular Employee Group/Union Affiliation: NUE-CO-02|NUE|Non Union Employee Job Level: Manager with Direct Reports Department: Northfield Support Services - HealthInforMgmt Administratn - 1608 Pay Range: $105400 - $136290 / year The ranges posted above reflect the location in the job posting. The salary range may vary if you reside in a different location or state than the location posted. Travel: Yes, 10 % of the Time Remote: Work location is the remote workplace (from home) within KP authorized states. Worker location must align with Kaiser Permanente's Authorized States policy. At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing. 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. Submit Interest

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