Job Description

Job Description

Job Description

The work of the Remote Medical Coder III involves, but is not limited to: review, assignment, and editing of diagnosis, material, medication, procedure, and supply codes for professional service and facility components of inpatient, ambulatory surgical services (i.e., day surgery), observation, Emergency Department, outpatient specialty, External Resource Sharing Agreement (ERSA), and billable outpatient primary care encounters; use of International Classification of Diseases (ICD- latest version) diagnosis and/or procedural codes, American Medical Association Current Procedural Terminology (CPT®) codes, Healthcare Common Procedure Coding System (HCPCS), Current Dental Terminology (CDT®) codes, Diagnostic Related Groups (DRG's), or other code taxonomies used to describe the provision of medical services for one or more medical conditions; uses military medical systems to remotely code facility and/or professional services, inpatient, ambulatory surgical, Emergency Department or outpatient encounters in providing contingency assistance to other DHA MTFs; and may assist the DHA MCPB in supporting coding compliance by performing focused or targeted audits on DHA Markets, DHARs, MTFs, specialties, product lines, providers, clinical staff, or coding staff.

Education : a minimum of one of the following:

An associate’s degree or higher in Health Information Management or Healthcare Administration or biological science; OR A university, college, or technical school certificate in medical coding; OR At least 30 semester hours’ university/college credit of a grade of “C”, “Pass”, or better, that includes relevant coursework such as anatomy/physiology, medical terminology, health information management, and/or pharmacology; OR Successful completion of an American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) online or in-person coding exam preparation course that includes medical terminology, anatomy and physiology, health information management concepts, and pharmacology; OR Successful completion of a training course beyond apprentice level for medical technicians, hospital corpsmen, medical service specialists, or hospital training, obtained in a training program given by the Armed Forces or the U.S. Maritime Service under close medical and professional supervision.

Required/Mandatory Knowledge/Skills/Abilities (must be able to demonstrate)

Advanced knowledge of the International Classification of Diseases, Clinical Modification (ICD-CM), and Procedural Coding System (PCS); Healthcare Common Procedure Coding System (HCPCS); and Current Procedural Terminology (CPT).

Advanced knowledge of reimbursement systems, including Prospective Payment System (PPS) and Diagnostic Related Groupings (DRGs); Ambulatory Payment Classifications (APCs); and Resource-Based Relative Value Scale (RBRVS).

Advanced knowledge and understanding of industry nomenclature; medical and procedural terminology; anatomy and physiology; pharmacology; and disease processes.

Practical knowledge of medical specialties; medical diagnostic and therapeutic procedures; ancillary services (includes, but is not limited to, Laboratory, Occupational Therapy, Physical Therapy, and Radiology); and revenue cycle management concepts.

Practical knowledge and understanding of Government rules and regulations regarding medical coding, reimbursement guidelines, and healthcare fraud; commercial reimbursement guidelines and policies; coding audit principles and concepts, and potential areas of risk for fraud and abuse. Includes, but is not limited to: The Federal Register, Center for Medicare, and Medicaid Services (CMS) Local Coverage Determinations and National Coverage Determinations (LCD and NCD), National Correct Coding Initiative (NCCI) guidance, manual, and edits, Internet-Only Manuals (IOMs), and HHS-OIG publications and reports.

Practical knowledge of revenue cycle management, project management concepts, business analysis, training methods, clinical documentation improvement, and continuous process improvement processes.

Practical knowledge of Current Dental Terminology (CDT).

Required Coding Certifications

Must possess a coding certification in good standing in each of the following categories:

Professional Services Coding Certifications:

ONE of the following recognized professional coding certifications: Registered Health Information Technician (RHIT); Registered Health Information Administrator (RHIA); Certified Professional Coder (CPC); or Certified Coding Specialist – Physician (CCS-P). Other professional coding certifications will be considered by the DHA-MCPB on a case-by-case basis.

Institutional (Facility) Coding Certifications:

ONE of the following recognized institutional coding certifications: Registered Health Information Technician (RHIT); Registered Health Information Administrator (RHIA); Certified Inpatient Coder (CIC), or Certified Coding Specialist (CCS). Other institutional coding certifications will be considered by the DHA-MCPB on a case-by-case basis.

NOTE: The AHIMA RHIT or RHIA credential may be counted towards either the professional services or institutional coding certification requirement, but not both unless the individual possesses the required institutional AND professional services experience for the specific position sought.

Evaluation & Management (E&M) Coding or Auditing Certifications:

ONE of the following recognized E&M coding certifications:

1) AAPC: Certified Evaluation & Management Coder (CEMC); OR

2) National Alliance of Medical Auditing Specialists (NAMAS): Certified Evaluation and Management Auditor (CEMA).

Experience

A minimum of five (5) years of medical coding and/or auditing experience in four or more medical, surgical, and ancillary specialties within the past fifteen (15) years. A minimum of one (1) year of performance in the specialty is required to be qualifying. Multiple specialties encompass different medical specialties (i.e., Family Practice, Pediatrics, Gastroenterology, OB/GYN, etc.) that utilize ICD, E&M, CPT, and HCPCS codes. Ancillary specialties (PT/OT, Radiology, Lab, Nutrition, etc.) that usually do NOT use E&M codes do not count as qualifying experience. Coding experience should include inpatient facility and ambulatory surgery areas. Additionally, coding, auditing, and training exclusively for specialties such as home health, skilled nursing facilities, and rehabilitation care will not be considered as qualifying experience. Coding experience limited to making codes conform to specific payer requirements for the business office (insurance billing, accounts receivable) is not a qualifying factor.

Candidates must pass a pre-employment coding compliance test based on the required knowledge and experience with a score of 70% or better.

Travel (3-5% a year) may be required to Medical Treatment Facilities (MTF) or main government location.

Must meet the eligibility requirements for a security clearance (US citizenship is a requirement).

Proof of immunizations, including COVID vaccination, required.

FOR QUALIFIED CANDIDATES MEETING THE EXPERIENCE AND EDUCATION REQUIREMENTS BUT NOT POSSESSING THE REQUIRED CERTIFICATIONS, THE COMPANY MAY BE WILLING TO SPONSOR THE REQUIRED TRAINING/TESTING FOR CREDENTIALS. SIGNING AN AGREEMENT WITH COMMITMENT TERMS WOULD BE REQUIRED.

This contractor and subcontractor shall abide by the requirements of 41 CFR 60-1.4(a), 60-300.5(a) and 60-741.5(a). These regulations prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, sexual orientation, gender identity or national origin. Moreover, these regulations require that covered prime contractors and subcontractors take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

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