DESCRIPTION OF WORK

Responsible for assignment of accurate Evaluation and Management (E&M) codes, International Classification of Diseases, Clinical Modification (ICD-CM), current procedural terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS), modifiers and quantities derived from medical record documentation (paper or electronic) for outpatient encounters. Trains and educates Military Treatment Facility (MTF) staff on coding issues and plays a significant role in coding compliance activities. Identifies and abstracts information from medical records (paper or electronic) for special studies and audits, internal and external. Interacts with MTF staff to ensure documentation is clear and supports coding assignments. Educates MTF staff through individual or group in-services and training sessions. Maintains a delinquency report of missing records in order to facilitate completion of work within the required thresholds. Practical knowledge of reimbursement systems, including, but not limited to, Ambulatory Payment Classifications (APCs); and Resource-Based Relative Value Scale (RBRVS). Practical 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. Reviews encounter and/or record documentation to identify inconsistencies, ambiguities, or discrepancies that may cause inaccurate coding, medico-legal repercussions or impacts quality patient care. Identifies any problems with legibility, abbreviations, etc., and brings to the provider’s attention. Develops and submits a written (electronic or hard copy) query IAW Defense Health Agency (DHA) DHA or Air Force Medical Service (AFMS) guidelines to the provider to request clarification of provider documentation that is conflicting, ambiguous, or incomplete in regards to any significant reportable condition or procedure. Monitors query submission, response times, and completion. Educates and provides feedback to providers and clinical staff to resolve documentation issues to support coding compliance.

DESCRIPTION OF EXPERIENCE REQUIRED

The candidate must have three (3) years of medical coding and/or auditing experience in two (2) or more medical, surgical and ancillary specialties within the past 10 years (non-ancillary specialties such as PT/OT, Radiology, Lab, Nutrition, etc., are NOT considered relevant experience).

DESCRIPTION OF CURRENT AND ACTIVE CERTIFICATIONS REQUIRED

The candidate must have...

• Must possess a current Basic Life Saving (BLS) Certification. (Must be American Heart Association (AHA) certified)
• Registered Health Information Technologist (RHIT) -or- Registered Health Information Administrator (RHIA) -or- Certified Professional Coder (CPC) CCS-P (Certified Coder Specialist – Physician)
• Evaluation and Management (E&M) Auditor Certification from the National Alliance of Medical Auditing Specialists (NAMAS) Certified Evaluation and Management Auditor (CEMA) - required as soon as possible upon hire.
• Have required continued education hours from an accrediting institution recognized by the American Health Information Management Association (AHIMA) and/or American Academy of Professional Coders (AAPC) must accredit education.

DESCRIPTION OF OTHER QUALIFICATIONS
The candidate must have...

• Excellent computer/communication skills for provider and staff interactions.
• Knowledge of anatomy/physiology and disease process, medical terminology, coding guidelines (outpatient), documentation requirements, familiarity with medications and reimbursement guidelines; and encoder experience.
• Handle multiple projects and appropriately prioritize tasks to meet deadlines.
• Pass a security background check in order to receive base access and access to US Government computer systems.

DESCRIPTION OF EXPERIENCE DESIRED

• Any work with Armed Forces Health Longitudinal Technology Application (AHLTA)
• Any work with Composite Health Care systems (CHCS) and/or MHS GENESIS
• Any Defense Enrollment Eligibility Reporting System (DEERS)
• Any work with Military Filing Systems - by sponsor social security number, terminal digit order, color-coded and blocked filing system
• Any work with EssentrisTM, the client-server version of the Clinical Information System (CIS)
• Any work with Coding Compliance Editor (CCE) Systems
• Any work with Biometric Data Quality Assurance Service (BDQAS)
• Any work with MHS Coding