Medical Coding Modernization Specialist

We are looking for a full time Medical Coding Modernization Specialist to join our team!

This full-time 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, Resource-Based 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.

QUALIFICATIONS:

• Successful completion of academic requirements, at least at an associate's degree level from a health information management program is required.
• A Registered Health Information Technician (RHIT) or equivalent certification is required.
• Other coding certifications may be considered but will require Government acceptance in accordance with the Equivalency Determination Request process outlined in Section H.3.f.(3) of the main contract.
• Continuing Education Requirements:
• Medical Coding Modernization Specialists will maintain the required continuing education hours and credentials as required by their national association certification at their own expense.
• 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:
• Auditing functions include development and execution of audit plan, conducting audit according to audit plan by reviewing required documentation and determining compliance with audit standards, communicating with stakeholders during all phases of audit, and reporting on audit findings.
• Training functions include identifying coding training opportunities; developing coding training plans, and development/delivery of coding training to coder and physician/provider audiences.
• Compliance functions include identifying compliance issues and analyzing practice patterns and recommending changes to policies and procedures; recommending/updating standard policies and procedures; contribute to risk assessments and mitigation strategies; and data collection and statistical report generation.