[Hiring] Compliance Consultant IV - Medical Coding - Risk Adjustment @Kaiser Permanente

Role Description

The Compliance Consultant IV, Medical Coding independently reviews inpatient, outpatient, professional, and supplemental medical records to assign supported ICD-10-CM diagnosis codes and applicable hierarchical condition categories. The coder validates that each reported condition is documented by an eligible provider, supported by the medical record, captured from an acceptable encounter, and coded in accordance with official guidelines, regulatory requirements, and organizational policies. The role requires advanced proficiency in risk adjustment coding platforms, electronic medical records, encoder applications, understanding of documentation cues, and production reporting tools. The Senior Coder is expected to resolve complex documentation and coding issues, recognize unsupported or conflicting diagnoses, document coding rationale, and escalate potential compliance concerns. All coding decisions must be defensible, traceable, and suitable for internal review or external audit.

Essential Responsibilities

• Practices self-development and promotes learning in others by proactively providing information, resources, advice, and expertise.
• Builds relationships with cross-functional stakeholders; influences others through technical explanations and examples.
• Adapts to competing demands and new responsibilities; listens and responds to performance feedback.
• Completes work assignments and supports business-specific projects by applying expertise in subject area.
• Ensures team follows all procedures and policies; coordinates resources to accomplish priorities and deadlines.
• Collaborates cross-functionally to make effective business decisions; solves complex problems.
• Conducts company compliance activities by collaborating with internal and external stakeholders.
• Develops compliance reports by evaluating and summarizing compliance data, audit information, and potential risks.
• Conducts compliance investigations by collecting and analyzing quantitative and qualitative data.
• Assists with and supports the management of projects or compliance components of larger cross-functional projects.
• Assists with ensuring regulatory compliance by monitoring regulatory changes.
• Coordinates the implementation of compliance efforts by identifying compliance requirements and assessing the current state of compliance.

Qualifications

• Minimum four (4) years medical coding experience.
• Bachelors degree in Health Care Administration, Clinical, Law, Public Health, Business or related field.
• Minimum six (6) years experience in health care compliance, health care operations, audit, finance, regulatory or public policy development, investigations, information security, or insurance/health plan governance.
• Certified Risk Adjustment Coder from American Academy of Professional Coders OR Certified Coding Specialist from American Health Information Management Association OR Certified Professional Coder from American Academy of Professional Coders.