Coding and Compliance Analyst

Description Create documented coding educational materials to enable Group Health Cooperative to meet and maintain compliant coding standards. Design, develop and implement coding educational materials for audiences that may include practitioners, ancillary clinical staff, Business Operations and CIS staff. Conduct needs assessments to determine priorities and best approaches to the delivery of coding educational materials. Develop policies and guidelines based on extensive research to meet the standards of coding compliance. Act as a coding resource to staff throughout Group Health Cooperative. Interpret and articulate complex coding compliance issues. Decipher information from Medicare, Medicaid, Labor and Industries, CPT Assistant, Coding Clinic. etc. Design educational materials using a variety of approaches and resources utilizing adult educational principles. Evaluate the effectiveness of educational programs including compliant coding practices post education. Demonstrate collaboration, partnership and technical skills to enable effective work with members of the Group Health Permanente Medical Group as well as health information technology staff throughout the Cooperative.

Requirements Experience requirements Minimum:  5 years progressively responsible experience in ICD-9-CM, CPT and HCPCS coding in a clinic setting including chart auditing experience. Progressively responsible roles in clinical, coding, business and training areas. Experience in application of compliant coding principles, including Medicare compliance issues. Demonstrated ability to implement up to date and compliant coding information in a complex clinical setting.   Preferred:   7+ years progressively responsible experience in ICD-9-CM, CPT and HCPCS coding in a multispecialty practice, hospital professional and hospital facility setting, including chart auditing experience. Demonstrated success working with delivery system staff including creating and delivering formal and informal educational and web based programs. Progressive experience in application of compliant coding principles including Medicare compliance issues. Progressive experience demonstrating ability to implement up to date and compliant coding information in a complex clinical setting. Demonstrated experience in enterprise clinical information systems, e.g. EpicCare. Demonstrated skills in project management including all related project management skills necessary to complete complex compliant coding research projects.
Knowledge requirements Minimum:  Presentation, customer service and interpersonal skills. Ability to interact effectively as a project manger. Conflict resolution and problem solving skills. Extensive computer skills and ability to learn new computer applications quickly and independently. Demonstrated decision-making ability. Project management skills. Knowledge of adult learning theory and various instructional approaches. In-depth knowledge of ICD-9-CM, CPT and HCPCS coding. Knowledge of medical terminology and medical science and disease processes, anatomy and physiology. Knowledge of healthcare billing and reimbursement, industry-standard billing rules, including Medicare, Medicaid, L&I and commercial insurance. Knowledge of Medicare compliance issues and working knowledge of APCs and DRGs.  Preferred:  Knowledge of Medicare compliance issues and extensive knowledge of healthcare billing and reimbursement in a fee-for-service environment. Knowledge of industry-standard billing rules, including Medicare, Medicaid, L&I and commercial insurance. Knowledge of APCs and DRGs. Demonstrated skills in using enterprise clinical information systems, particularly EpicCare.
Education requirements Minimum:  Bachelors Degree in healthcare field OR 5 years equivalent experience.  Preferred:  Bachelors degree in healthcare or education related major, i.e. RHIA or BSN. Masters degree in healthcare, education or business related major.
Certification requirements Minimum:  Coding Certification, CPC or CCS-P.  Preferred:  None

Group Health is an Equal Opportunity Employer committed to a diverse and inclusive workforce.