Outpatient Coder Specialist

Under supervision, is responsible for assigning accurate diagnosis and procedure codes to the patients' health information records, for: Observation, Hospital Ambulatory Surgery, Complex Hospital Outpatient Visit {Cardiac Catheterization (Percutaneous Coronary Intervention) Lab, Interventional Radiology}, Emergency Departments, and other select OP records. This responsibility requires appropriate code assignment for physician-documented patient diagnoses, conditions and procedures; utilizing various coding classification schemes including ICD- 10CM (may include PCS), and HCPCS/CPT.
All work will be carried out in accordance with the: International Classification of Diseases - Official Coding Guidelines for coding and reporting as established by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS); American Medical Association (CPT) National Correct Coding Initiative (NCCI), and Kaiser Permanente organizational/institutional coding directives. Ability to communicate with physicians in order to obtain clarification for diagnoses/procedures. Ability to understand the clinical content of the health record and abstract the data in the patient health information record data as well as perform other duties as assigned.

• • Upholds and maintains Maui Health Systems Policies and Procedures, Principles of Responsibilities and all applicable state, federal and local laws.

• • Reviews patient health information record to identify and assign appropriate codes for diagnoses, procedures, and other services rendered.

• • Appropriately assign and sequence codes for diagnoses, procedures and other services as needed for proper Ambulatory Payment Classification (APC) assignment, utilizing the applicable coding conventions.

• • Serves as a consultant to care providers.

• • Identifies discrepancies, potential quality of care, and billing issues.

• • Research, analyzes, recommends and facilitates plan of action to correct discrepancies and prevent future coding errors.

• • Interacts with physicians through established query process in order to clarify documentation supporting accurate patient diagnostic and procedure coding.

• • Abstracts patient information into the computerized systems, in a manner ensuring the accuracy and integrity of the data.

• • Ensures timely coded record availability according to regulatory guidelines, by meeting established coding and abstracting productivity standards.

• • Ensures quality standards by meeting the established 95% coding accuracy and 98% completeness quality standards.

• • Maintains and complies with HIPAA policies and procedures for privacy and confidentiality of all patient records.

• • Attends and participates in selected national, regional and coding educational sessions.

• • Works collaboratively with others on coding questions and issues.

• • Demonstrates knowledge of system security, by complying with KP Electronic Assets Usage Policy.

• • Maintains courteous and cooperative relations when interacting with others.

• • Performs other duties as assigned.

• • Minimum one (1) year of Certified Coding experience.

• • High school diploma or General Education Diploma (GED) required.

• • Post high school coursework in medical records administration, anatomy, physiology and medical terminology.

• • Certified Coding Specialist OR Registered Health Information Technician OR Registered Health Information Administrator OR Certified Professional Coder

• • Demonstrated competence with personal computers, networks, and Microsoft Office.

• • Experience with International Classification of Diseases (ICD-10), Current Procedure Terminology (CPT4), and Healthcare Common Procedure Coding System (HCPCS) coding system, and other related documentation requirements.

• • Demonstrated ability to understand clinical content of a health record.

• • Minimum three (3) consecutive years of experience as a Certified Hospital Coder.

• • Previous experience of coding in a hospital license space.

• • Successful completion of Certified Coding Specialist Program through American Health Information Management Association (AHIMA).