Coding Integrity Specialist

May 19 2017
MDX Hawai'i |Honolulu|Full Time
Category: Healthcare
Job Description


The Coding and Integrity Specialist’s (Coder) purpose is to assure that the provider documentation in the medical records accurately support any information provided in claims, reports or attestations to MDX Hawaii.  In addition, the Coder will support preventive health programs through the review and documentation of CMS and MDX Hawai‘i  quality measures.  The Coding Integrity Specialist performs accurate and timely review and validation of chronic conditions through medical records and risk adjustment vendors.  The Coder will lead efforts to evaluate the chronic condition auditing processes and provide analyses and recommendations to improve overall provider documentation and coding. The Coder will review medical records to determine if diagnostic and procedure codes are accurately reflecting the provider documentation. The Coder will assist healthcare providers and clinics in identifying and resolving issues related to incomplete or missing chart documentation, ambiguous or nonspecific documentation or codes that do not conform to regulatory guidelines or MDX Hawai’i internal controls.  The Coding Integrity Specialist is also responsible for medical record abstraction as assigned per HEDIS specifications, productivity and accuracy requirements.  The coder will summarize findings for internal and external parties to help providers improve their documentation and coding. They will be educating, training and providing assistance in a variety of ways to help providers and staff close gaps in diagnoses and treatment opportunities.


TYPICAL WORKING CONDITIONS:Office based position; subject to inside environmental conditions (temperature fluctuations of air-conditioned office), not substantially subjected to adverse external environmental conditions.  Subject to noise from various types of office equipment, including but not limited to: typewriters, copy machines, faxes, printers and computers.  May be exposed to chemicals and/or fumes (e.g. copy toner or cleaning fluid).  Incumbent will work in the office setting, provider office settings and other locations where meetings, demonstrations, evaluations and/or training sessions are performed.  May require travel via own automobile or day/overnight travel on Oahu and to the Neighbor Islands and/or the Mainland. 



1.       Ability to multitask and function in a high volume/busy environment. Ability to work calmly under pressure and appropriately plan, prioritize, organize and carry out tasks and responsibilities. 

2.       Essential: finger dexterity, hearing, speaking, seeing, frequent gripping of an object for prolonged periods, carrying usual amounts of 5 – 30 lbs., lifting and pushing/pulling usual amount of 5 – 30 lbs. 

3.       Continuous:  Prolonged sitting, finger dexterity, hearing, speaking.

4.       Frequent: Stooping, bending, kneeling and crouching.

5.       Occasional   Standing, walking, crawling, twisting body, reaching at shoulder level or above, lifting/pushing/pulling of maximum 25 pounds for 100 yards.

6.       Good decision making and communicating skills. Ability to motivate people. Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.  Ability to write routine reports, correspondence and procedure manuals.  Ability to speak effectively before groups of customers or employees of organization.  Ability to effectively present information and respond to questions from groups of managers, clients, customers and the general public. 




1.       High School Graduate required and Associates or Bachelor degree preferred

2.       Certified Professional Coder (CPC) or Certified Medical Coder (CMC) with certification from the American Academy of Professional Coders (AAPC); graduate of a comparable Healthcare/HIM program eligible to sit for Certified Professional Coder (CPC), Certified Medical Coder (CMC) or an experienced coder with the Certified Coder Specialist (CCS) credentials would also be considered.

3.       Two or more years of experience in managed care or the health care industry with focus on government programs strongly preferred. 

4.       Experience with HEDIS record collection and analytical review and/or Quality Improvement and risk adjustment coding in a physician office preferred.

5.       Maintains credentials by meeting AHIMA/ AAPC continuing education requirements.

6.       One year of specialty claims processing experience preferred. 


1.       Ability to calculate figures and amounts such as discounts, proportions, and percentages.  

2.       Ability to apply concepts such as factions, percentages, ratios, and proportions to practical situations. 


1.       Ability to understand basic billing and coding concepts.  Ability to define problems, collect data, establishes facts, and draw valid conclusions.

2.       Ability to solve practical and technical problems and deal with a variety of concrete variables in situations where only limited standardization exists. 

3.       Ability to interpret a variety of instructions furnished in written, oral, diagram or schedule form. 


1.       Current/valid Hawai‘i Driver’s License.

2.       Proof of Hawai‘i No-Fault Auto Insurance.

3.       Clean driving record as evidenced by a recent driver’s abstract (to be provided by the employee.)

4.       Certified Coding Specialist (CCS) 


1.       Broad knowledge of insurance plans, regulations and compliance.  Knowledgeable in general coding of Medicare and payer guidelines and broad knowledge of Medicaid and commercial insurance plans.

2.       Demonstrated intermediate knowledge of CPT, ICD, HCPCS, DRG's and revenue code sets gained either through complex specialty claims processing or equivalent formal coding training.

3.       Knowledge and understanding of CMSHCC risk adjustment coding and data validation requirements and CMS Quality Stars Program for Medicare.

4.       Accurate typing of 50 wpm and proficient operation of office machines such as personal computer, typewriter, transcription equipment, copy machine, calculator, FAX machine, multi-line telephone, etc.

5.       Proficiency in computer usage including database and spreadsheet analysis, presentation programs, word processing and Internet searching (e.g. Microsoft Word, Excel, Access and PowerPoint).

6.       Ability to learn new computer applications quickly and independently and become a skilled user of the company’s proprietary database. Demonstrated familiarity with a variety of practice management software, including: EMR(s).

7.       Demonstrates adaptability and self-motivation by staying abreast of CMS rules and regulations and incorporating those changes into daily practice.

8.       Demonstrated ability to establish and maintain rapport with co-workers, physicians and other health care providers.

9.       Demonstrated ability to perform tasks independently and with minimal supervision.




MDX Hawai‘i

Attention:  Human Resources

500 Ala Moana Boulevard, Suite 2-200

Honolulu, Hawaii  96813

Telephone:  (808) 522-7500