Senior Medical Coding Compliance Specialist

Kaiser Permanente; Pasadena (CA); On-site; USD 90,000 - 120,000; Full time

Job summary

Kaiser Permanente is seeking a Compliance Consultant III, Medical Coding to independently review records and assign ICD-10-CM codes and related risk adjustment categories. The role includes ensuring documentation supports coding decisions and adherence to regulatory standards, with focus on risk adjustment and compliance across multiple settings.

The position emphasizes collaboration, auditing support, and maintaining defensible coding rationales for internal and external audits.

Qualifications

• Minimum two (2) years medical coding experience.
• Bachelor's degree plus 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.
• 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

Responsibilities

• Reviews inpatient, outpatient, professional, and supplemental medical records to assign ICD-10-CM diagnosis codes and applicable hierarchical condition categories.
• 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.
• Resolves complex documentation and coding issues, recognizes unsupported or conflicting diagnoses, documents coding rationale, and elevates potential compliance concerns.
• Performs compliance reporting tasks by monitoring, compiling data, identifying risks, and reporting to senior team members on key drivers and performance indicators.
• Assists with auditing assigned lines of business for coding and supports the development of audit result reports and related compliance deliverables

Education

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

Job description

Kaiser Permanente is seeking a Compliance Consultant III, Medical Coding to independently review records and assign ICD-10-CM codes and related risk adjustment categories. The role includes ensuring documentation supports coding decisions and adherence to regulatory standards, with focus on risk adjustment and compliance across multiple settings.

The position emphasizes collaboration, auditing support, and maintaining defensible coding rationales for internal and external audits.