Job Summary:
Under direct supervision, is responsible for professional service and ancillary coding for ambulatory/medical office, hospital inpatient and hospital outpatient department records and/or other select records. This will require utilizing various coding classification schemes including ICD-9CM/ ICD-10CM, CPT (including E&M and HCPCS Level II and modifiers). Appropriate codes will be assigned for diagnoses, procedures, evaluation & management services, supplies, materials and injections including modifiers. All work is carried out in accordance with the Uniform Hospital Discharge Data Set (UHDDS) guidelines, coding conventions as established by the American Hospital Association (National Coding Guidelines/Coding Clinic), American Medical Association (CPT), Rules and Regulations of the Center for Medicare and Medicaid Services (CMS), Kaiser Permanente organizational/institutional coding guidelines.

Essential Responsibilities:

Essential Duties:

Upholds Kaiser Permanentes Policies and Procedures, Principles of Responsibilities and applicable state, federal and local laws.

Assigns and sequences codes for diagnoses, procedures, professional services and other services as needed utilizing the applicable coding conventions as stated above per regulatory guidelines.

Reviews coding claim edits and functions.

Ensures that all coded data is consistent with federal and state regulations and organizational policy as it relates to corporate compliance policy for accurate coding.

Interacts with physicians through a query process to clarify documentation to support accurate patient diagnostic and procedural information.

Enters coded information into a manual or computerized system as required, ensuring the accuracy and integrity of the data.

Maintains timely coding productivity and 95% quality standards.

Participates in medical record documentation review.

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

Demonstrates knowledge of security of systems by not sharing computer logons.

Attends and participates in selected national, regional and local documentation and coding education sessions.

Works collaboratively with others on coding questions and issues.

Answers the telephone promptly and identifies self and department.

Maintains courteous and cooperative relations when interacting with others.

Performs other duties as assigned by supervisor.

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

Demonstrates knowledge of security of systems by not sharing computer logons.

Attends and participates in selected national, regional and local documentation and coding education sessions.

Works collaboratively with others on coding questions and issues.

Answers the telephone promptly and identifies self and department.

Maintains courteous and cooperative relations when interacting with others.

Performs other duties as assigned by supervisor

Reviews medical records to identify diagnoses, procedures, professional service level and other services and supplies.

Basic Qualifications: Experience

Minimum one (1) year of experience as a certified coder.

Per the National Agreement, current KP Coalition employees have this experience requirement waived.

Education

Completion of classes in Medical Terminology, Anatomy/ Physiology, ICD-9/ ICD-10 and CPT coding conventions conforming to standards established by the American Hospital Association (Coding Clinic), American Medical Association, CMS, or successful completion of an AAPC or AHIMA accredited coding certification program.

License, Certification, Registration

Certified Professional Coder - Hospital Outpatient OR Certified Professional Coder OR Certified Coding Specialist

Additional Requirements:

Obtain a passing score on a Kaiser Permanente Professional Services Coder I coding assessment.
Ability to understand the clinical content of a health record.
Ability to effectively communicate with physicians and other healthcare providers.
Ability to perform within acceptable established quality standards.
Keyboarding skills.

Preferred Qualifications:

Candidates with ICD-10 CM and/or PCS work experience, may have those years of experience considered and counted towards the career ladder program.