Compliance Consultant IV, Medical Coding

The Compliance Consultant Medical Coding role partners across Kaiser Permanente teams to enhance coding accuracy, elevate documentation quality, and guide the implementation of strategic, compliant Risk Adjustment workflows.

This role supports enterprise operations through expert application of coding guidelines, strong understanding and comprehension of clinical standards, development of policies and procedures, and contributions to audit readiness. It also strengthens collaboration with PMGs and providers by co-designing workflows, supporting testing, and ensuring technology integration aligns with operational goals. Through strategic insight and disciplined process improvement, the Compliance Consultant Medical Coding helps advance scalable, compliant solutions that drive the success of Kaiser Permanente-s enterprise Risk Adjustment initiatives.\

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

• Practices self-development and promotes learning in others by proactively providing information, resources, advice, and expertise with coworkers and customers; building relationships with cross-functional stakeholders; influencing others through technical explanations and examples; adapting to competing demands and new responsibilities; listening and responding to, seeking, and addressing performance feedback; providing feedback to others; creating and executing plans to capitalize on strengths and develop weaknesses; supporting team collaboration; and adapting to and learning from change, difficulties, and feedback.
• Completes work assignments and supports business-specific projects by applying expertise in subject area; supporting the development of work plans to meet business priorities and deadlines; ensuring team follows all procedures and policies; coordinating resources to accomplish priorities and deadlines; collaborating cross-functionally to make effective business decisions; solving complex problems; escalating high priority issues or risks as appropriate; and recognizing and capitalizing on improvement opportunities.
• Conducts company compliance activities by collaborating with internal and external stakeholders; applying established regulations and standards to compliance efforts; providing insight and recommendations for the design, development, and execution of strategic compliance initiatives; and documenting compliance activities.
• Develops compliance reports by evaluating and summarizing compliance data, audit information, and potential risks and remedies; reporting to management on key compliance drivers, liabilities, and performance indicators (for example, adherence to standards, incorporation of new regulations); and developing draft presentations to convey key findings.
• Conducts compliance investigations by collecting and analyzing quantitative and qualitative data; conducting interviews as appropriate; researching key business issues; identifying potential action steps; and providing input for the creation of corrective action plans for substantiated allegations.
• Assists with and supports the management of projects or compliance components of larger cross-functional projects by coordinating stakeholder contacts; recommending team resources based on project needs and team member strengths; assisting in the development, analysis, and management of project plans; and coordinating project schedules and resource forecasts.
• Assists with ensuring regulatory compliance by monitoring regulatory changes; conducting analysis on regulatory impacts; and supporting the implementation of designated changes.
• Coordinates the implementation of compliance efforts by identifying compliance requirements; assessing the current state of compliance to identify gaps and corrective actions; creating or revising moderately complex compliance standards, policies and procedures, and training; and monitoring ongoing compliance adherence.

• Minimum four (4) years medical coding experience.
• Bachelors degree in Health Care Administration, Clinical, Law, Public Health, Business or related field and Minimum six (6) 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 Coding Specialist from American Health Information Management Association OR Certified Professional Coder from American Academy of Professional Coders

• Four (4) years hospital coding experience.
• Four (4) years coding audit experience.

PrimaryLocation : California,Pasadena,Walnut Center - Regional Offices
HoursPerWeek : 40
Shift : Day
Workdays : Mon, Tue, Wed, Thu, Fri
WorkingHoursStart : 08:00 AM
WorkingHoursEnd : 05:00 PM
Job Schedule : Full-time
Job Type : Standard
Employee Status : Regular
Employee Group/Union Affiliation : NUE-PO-01|NUE|Non Union Employee
Job Level : Individual Contributor
Job Category : Compliance, Privacy & Regulatory
Department : Po/Ho Corp - Medicare LOB Admin - 0308
Travel : No
Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.