Outpatient Coder Specialist; Maui Health

Job Summary

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.

Essential Responsibilities

• 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.