Outpatient Coder Specialist; Maui Health

Kaiser Permanente; Wailuku (HI); On-site; USD 70,000 - 95,000; Full time

Job summary

Kaiser exposes an Outpatient Coder Specialist role at Maui Health in Wailuku, Hawaii. The position requires coding diagnoses and procedures across ambulatory settings including observation, surgeries, ED, and other records, using ICD-10-CM, CPT4, and HCPCS guidelines.

Engage with physicians to clarify documentation, ensure data integrity, and meet regulatory quality metrics while upholding privacy and security policies.

Qualifications

• Certified coding credentials (e.g., CCS, RHIT, RHIA, CPC) required.
• Post-high school coursework in medical records and terminology.
• Experience with ICD-10, CPT4, HCPCS coding systems.
• Knowledge of CMS/NCHS guidelines and NCCI.

Responsibilities

• Identify and assign codes for diagnoses, procedures and services.
• Sequence codes for APC assignment using coding conventions.
• Serve as a consultant to care providers.
• Identify discrepancies, research and propose corrective actions.
• Query physicians to clarify documentation for accuracy.
• Abstract patient information into computerized systems.
• Ensure timely coded records and 95% accuracy, 98% completeness.
• Maintain HIPAA privacy and participate in coding education.

Skills

Certified Coding

HIPAA compliance

Physician communication

ICD-10 knowledge

CPT4 knowledge

HCPCS knowledge

Microsoft Office

Education

High school diploma or GED

Medical records coursework

Anatomy and physiology coursework

Medical terminology coursework

Job description

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.

Basic Qualifications:

Experience

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

Education

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

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

License, Certification, Registration

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

Additional Requirements:

• 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.

Preferred Qualifications:

• 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).

COMPANY: KAISER

TITLE: Outpatient Coder Specialist; Maui Health

LOCATION: Wailuku, Hawaii

REQNUMBER: 1402494

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.