Compliance Consultant III, Medical Coding

Kaiser Permanente; Pasadena (CA); On-site; USD 120,000 - 150,000; Full time

Job summary

Kaiser Permanente seeks a Compliance Consultant III to serve as a subject matter expert in healthcare compliance, coding, and documentation. The role conducts audits, analyzes findings, and develops actions to improve regulatory compliance and operations.

Responsibilities include supporting regulatory change management, developing audit reports, and assisting with corrective action plans. Collaboration with stakeholders and education initiatives are key to success.

Qualifications

• Minimum two (2) years medical coding experience.
• Bachelor's degree in Health Care Administration, Clinical, Law, Public Health, Business or related field; 3+ years experience in health care compliance or related field.

Responsibilities

• Pursues self-development and effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and customers; influencing others through technical explanations and examples; providing occasional mentoring to team members; listening and responding to, seeking, and addressing performance feedback; creating plans to capitalize on strengths and develop weaknesses; anticipating and responding to the needs of others; and adapting to and learning from change, difficulties, and feedback.

Education

Bachelor's degree in Health Care Administration, Clinical, Law, Public Health, Business or related field

Certified Risk Adjustment Coder (CRAC) / CCS / CPC certifications

Job description

The Compliance Consultant III serves as a subject matter expert in healthcare compliance, medical coding, documentation, and regulatory requirements. This role conducts coding and compliance audits, evaluates documentation and coding accuracy, analyzes audit findings and compliance risks, and develops recommendations to support regulatory compliance and operational improvement. The position provides consultative support to stakeholders on coding and compliance matters, assists with investigations and regulatory change management, and supports the development and implementation of compliance policies, educational initiatives, and corrective action plans.

Job Summary:

In addition to the responsibilities listed below, the position is responsible for serving as a compliance subject matter expert related to coding functions within assigned settings of care, maintaining compliance with national coding policies and procedures, assisting with coding questions and related topics, and assisting with auditing assigned lines of business for coding. Additionally, this position is responsible for assisting with the development of audit result reports and supporting compliance and the Principles of Responsibility (KPs code of conduct).

Essential Responsibilities:

• Pursues self-development and effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and customers; influencing others through technical explanations and examples; providing occasional mentoring to team members; listening and responding to, seeking, and addressing performance feedback; creating plans to capitalize on strengths and develop weaknesses; anticipating and responding to the needs of others; and adapting to and learning from change, difficulties, and feedback.
• Completes work assignments by applying up-to-date expertise in subject area to generate creative solutions; ensuring all procedures and policies are followed; leveraging an understanding of data, and resources to support projects or initiatives; collaborating cross-functionally to solve business problems; identifying and monitoring priorities, deadlines, and expectations; communicating progress and information; identifying, recommending, and implementing ways to address improvement opportunities; and escalating issues or risks as appropriate.
• Conducts company compliance activities under the guidance of more senior employees by providing support to internal and external stakeholders; applying established regulations and standards to compliance efforts; and documenting compliance activities.
• Assists with compliance reporting efforts by monitoring, and compiling compliance data and information to identify potential risks and remedies; researching, analyzing, and summarizing data; and reporting to senior team members on key compliance drivers, liabilities, and performance indicators (for example, adherence to standards, incorporation of new regulations).
• Assists with compliance investigation efforts by collecting and analyzing data; identifying misalignment with desired compliance actions; conducting interviews as appropriate; determining action steps for resolution; and providing input on corrective action plans.
• Provides support on projects by coordinating stakeholder contacts; assisting in the development, analysis, and coordination of project plans for compliance specific deliverables; and coordinating project schedules and resource forecasts.
• Assists with ensuring regulatory compliance by monitoring regulatory changes; acting on regulatory updates; and supporting the implementation of designated changes.
• Assists in the implementation of compliance efforts by identifying compliance requirements; supporting the assessment of current state compliance to identify gaps and corrective actions; supporting the creation or revision of basic compliance standards, policies and procedures, and training; and monitoring ongoing compliance adherence.

Minimum Qualifications:

• Minimum two (2) years medical coding experience.
• Bachelors degree in Health Care Administration, Clinical, Law, Public Health, Business or related field and Minimum three (3) years experience in health care compliance, health care operations (quality, risk, etc.), audit, finance, regulatory or public policy development, investigations, information security, or insurance/health plan governance or a directly related field. Additional equivalent work experience in a directly related field may be substituted for the degree requirement.

• 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

Preferred Qualifications:

• Two (2) years hospital coding experience.
• Two (2) years coding audit experience.