Medical Coding Modernization Specialist

MEDICAL CODING MODERNIZATION SPECIALIST

Pearl Harbor, HI

AAI is actively recruiting a Medical Coding Modernization Specialist. This position will support coding operations and compliance as part of the Medical Modernization Program. The coding professional will conduct internal audits; monitor coding practices and documentation deficiencies to identify, develop, deliver training and monitor effectiveness of efforts to ensure improvement to documentation, coding completion, timeliness and accuracy rates for the MTF.

RESPONSIBILITIES

• Knowledge of The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-CM), procedural coding, healthcare common procedure coding system (HCPCS)/current procedural terminology (CPT) nomenclature, medical and procedural terminology, anatomy and physiology, pharmacology, and disease processes to perform the duties described. Knowledge of reimbursement systems, including Prospective Payment System (PPS) and Diagnostic Related Groupings (DRGs); Ambulatory Payment Classifications (APCs); and, ResourceBased Relative Value Scale (RBRVS).
• Knowledge of and the ability to interpret guidelines, rules and regulations developed by: Centers for Medicare & Medicaid Services (CMS), American Medical Association (AMA), American Heart Association (AHA) and other applicable Federal requirements so as to provide timely and accurate information relating to coding, billing and documentation.
• Excellent oral and written communication skills, interpersonal skills along with the confidence to present complex medical coding issues and educational instruction to a diverse audience. Must be comfortable in front of high ranking, professional staff and coding peers to training and respond to questions.
• Ability to write reports, business correspondence, and procedure manuals.
• Organizational, analytical, time management, statistical, and problem-solving skills.
• Advanced knowledge of computers, keyboard skills, and various software programs including Microsoft (word processing, spreadsheet and database) as well as coding software programs.
• Medical Coding Modernization Specialists will maintain the required continuing education hours and credentials as required by their national association certification at their own expense.
• Work Environment/Physical Requirements. The work is primarily sedentary. Requirements may include prolonged walking, standing, sitting, or bending. Carrying or lifting of medical records or documentation may be required daily. Use of one or more computer programs and monitors simultaneously is typical and frequent.
• Assists the MTF in identifying medical coding deficiencies by analyzing documentation and coding practices that may be misrepresenting or incorrectly capturing medical care activities.
• Analyzes historical encounter documentation and coding records from Government computer systems and medical records to identify clinical documentation improvement (CDI) and training opportunities.
• Compares documentation to code application to ensure accuracy. Tracks deficiencies for trending and corrective action.
• Collaborates with MTF leadership, MTF providers/staff, and other coding professionals related to the performance of tasks to address recurring documentation and coding deficiencies, Contacts providers to review findings to improve documentation practices as well as E&M leveling, capturing medical procedures and to improve diagnosis specificity issues IAW with coding guidelines.
• Develops focused training presentations from thorough analysis as outlined in the MTF modernization action plan. Seeks Government approval prior to delivering Government scheduled training to MTF providers and other staff.
• Creates and submits training activity reports to the MTF leadership. Presents reports to the Government weekly and identifies scheduling issues and obstacles to meeting improvement objectives. Creates monthly reports showing completed activities and improvement to metrics
  

Education/Certification:
1. Successful completion of academic requirements, at least at an associate's degree level from a health information management program is required.
2. A Registered Health Information Technician (RHIT) or equivalent certification is required.

3. Must have successfully completed requirements for International Classification of Diseases, Tenth Revision ICD-10-CM/PCS proficiency certification by AHIMA standards or the AAPC ICD-10-CM proficiency test prior to their start date if an equivalency determination request for AAPC certification(s) is authorized by the Government.

Experience:

• Candidates will require a minimum of 10 years of medical coding experience in production coding environments within the past 10 years, in more than 4 medical and surgical specialties, involving assignment of ICD, E&M, CPT, and HCPCS codes. Coding, auditing and training for ancillary services such as physical, occupational therapy, speech, and nutritional medicine as well as home health, skilled nursing facilities, rehabilitation care and urgent care clinics are not qualifying.
A minimum of four years of auditing, training, and/or compliance functions within the last eight years is required in at least 4 medical and surgical specialties as stated above OR candidates with three years of auditing, compliance, or training experience involving professional coding within the last five years in a DoD coding environment may be considered in lieu of 10 years for those without DoD experience. Auditing, compliance, or training experience is described as:

UNIQUE MILITARY HEALTH CARE DYDTEMD/PROCEDURED:

• Armed Forces Health Longitudinal Technology Application (AHLTA).
• Composite Health Care System (CHCS) and/or MHS GENESIS.
• Defense Enrollment Eligibility Reporting System (DEERS).
• Essentris™ The client-server version of the Clinical Information System (CIS).
• Coding Compliance Editor (CCE).
• Biometric Data Quality Assurance Service (BDQAS)- https://bdqas.afms.mil/
• AFMS Internal Coding Audit Methodology – AFMOA Audit Tool/Coding Audit Review System (CARS), or current tool.
• MHS Coding Guidelines http://www.tricare.mil/ocfo/bea/ubu/coding_guidelines.cfm
• AFMS Centralized Coding Manual.

About AAI

AAI is focused on delivering outstanding services to the federal government. We have extensive experience in the fields of cyber security, development, IT infrastructure, supply chain management and other professional services such as system design and continuous improvement. AAI is a VA CVE-certified Service-Disabled Veteran-Owned Small Business (SDVOSB), SBA certified Economically Disadvantaged Woman Owned Small Business (EDWOSB), and a Woman Owned Small Business (WOSB) with offices in Hampton Roads Virginia, Montgomery, AL, Washington DC and Atlanta.

Fully qualified candidates are welcome to apply directly on our website at: https://aaionline.us/.

Our benefits include:

• Paid Federal Holidays
• Robust Healthcare and Dental Insurance Options
• 401a plan
• 401k plan
• Paid vacation and sick leave
• Continuing education assistance
• Short Term / Long Term Disability & Life Insurance.

Veterans are encouraged to apply

AAI does not discriminate in employment opportunities, terms and conditions of employment, or practices on the basis of race, age, gender, religious or political beliefs, national origin or heritage, disability, sexual orientation, or any characteristic protected by law. Pending guidance from the Safer Federal Workforce, employees may in the future be required to provide evidence of COVID-19 vaccination or request and receive approval for a medical or religious exemption.