Certified Professional Coder 4

Job Summary:

Ensures all technical aspects of the assignment of diagnostic and procedure coding is carried out in accordance with established standards and is in compliance with CMS, NCQA, third party payors, other regulatory agencies and Kaiser Permanente policy. Functions includes, but are not limited to working charge review work queues for reimbursable accounts for all internal and external surgical services. Serves as a technical coder for all specialties. Assists supervisor in responding to coding questions from other levels of coders and in responding to providers. Conducts special projects and focused reviews of encounters as requested.

Essential Responsibilities:

• Required to research and assign. HCPCS Level II codes for ambulatory surgical services and/or professional services performed. Ability to research, analyze and/or review detailed and high complexity code edits and transactions within the Kaiser Permanente system.
• Provides additional support to the coding staff by resolving complex cases and issues.
• Contributes to the development and maintenance of specialty specific education materials.
• Maintains current knowledge of coding conventions, guidelines, updates, and regulations governing government and third party billing to ensure that Kaiser Permanente Colorado coding and documentation meets regulatory guidelines and audit standards, and results in appropriate reimbursement.
• Must meet and maintain departmental Coding quality measures and production standards.
• Collaborates with clinical and non-clinical groups, to develop, implement and communicate specific coding and documentation guidelines that will fulfill the internal needs for complete and consistent clinical data.
• Serves as coding expert on various committees as requested.
• Supports compliance and Kaiser Permanentes Code of Conduct by adhering to federal and state laws and regulations, accreditation and license requirements, by policies and procedures. Responds appropriately to observed fraud and abuse.