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.