Ambulatory Procedure Visit (APV) Medical Coder (Coder II)

at  AAI

SUMMARY -

AAI is actively recruiting Ambulatory Procedure visit Medical Coder who is responsible
for assignment of accurate Evaluation and Management (E&M) codes, ICD diagnoses,
current procedural terminology (CPT) and Healthcare Common Procedure Coding
System (HCPCS), modifiers and quantities derived from medical record
documentation (paper or electronic) for ambulatory procedure visits.

REQUIRED EDUCATION

Candidates must possess post high school education or training from ONE of the following.

• An Associate’ degree or higher in Health Information Management orHealthcare Administration, healthcare-related major, or biological science
• A University certificate in medical coding
• At least 30 semester hours of University/College credit that includes relevantcoursework such as anatomy/physiology, medical terminology, health informationmanagement, and/or pharmacology
• Successful completion of an American Academy of Professional Coders(AAPC) or American Health Information Management Association (AHIMA) codingcertification preparation course for professional services or facility coding thatincludes medical terminology, anatomy and physiology, health informationmanagement concepts, and pharmacology
• 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 EXPERIENCE

Candidates must have experience in at least ONE of the following.

• A minimum of four (4) years of medical coding and/or auditing experience in two (2) or more medical,surgical, and ancillary specialties within the past 10 years
• A minimum of two (2) years of medical coding or auditing experience in a Military Treatment Facility (MTF) that includes a minimum of one (1) year of performance in the specialty

OTHER REQUIRED KNOWLEDGE, SKILLS, & ABILITIES

• Advanced knowledge of the International Classification of Diseases, Clinical Modification (ICD-CM); Healthcare Common Procedure Coding System (HCPCS); and Current Procedural Terminology (CPT), as used in institutional and professional services medical coding
• Advanced knowledge of reimbursement systems, including Prospective Payment System (PPS); 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, Dental, Occupational Therapy, Physical Therapy, and Radiology); and revenue cycle management concepts related to medical coding
• 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 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 report
• Practical knowledge of clinical documentation improvement and continuous process improvement processes

JOB DUTIES/RESPONSIBILITIES

• Position requires excellent computer/communication skills for provider andstaff.
• Knowledge of anatomy/physiology and disease process, medical terminology,coding guidelines (Outpatient and ambulatory surgery), documentationrequirements, familiarity with medications and reimbursement guidelines;and encoder experience.
• Candidate must have ability to handle multiple projects and appropriatelyprioritize tasks to meet deadlines.
• Accurately assigns diagnosis and procedure codes for facility and professional services for Ambulatory Procedure Visit (APV), Dental surgical procedures, Observation, Emergency Department (ED), outpatient ERSA, and Outpatient encounters IAW DHA completeness, productivity, and timeliness standards. Work may involve areas such as Laboratory, Radiology, and Dental services. Codes records with correct Ambulatory Payment Classifications (APCs); and Relative Value Units (RVUs) in order for the Center to receive correct reimbursement or workload credit. Performs necessary tasks within MHS GENESIS and other military coding systems to complete encounters. May be tasked with assisting with outpatient coding if available.
• Adheres to accepted coding practices, guidelines and conventions when choosing the most appropriate diagnosis, operation, procedure, ancillary, or E&M code to ensure ethical, accurate, and complete coding.
• Monitors ever-changing regulatory and policy requirements affecting coded information for the full spectrum of services provided.
• Maintains technical currency through continuing education and training opportunities.
• Reviews encounter and/or record documentation to identify inconsistencies, ambiguities, or discrepancies that may cause inaccurate coding, medico-legal re-percussions or impacts quality patient care. Identifies any problems with legibility, abbreviations, etc., and brings it to the provider’s attention. May perform assessments and examine records for proper sequence of documents, presence of authorized signatures, and sufficient data is documented that supports diagnosis, treatment administered, and results obtained. Develops and submits a written (electronic or hard copy) query IAW DHA guidelines to the provider to request clarification of provider documentation that is conflicting, ambiguous, or incomplete regarding 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. Assigns accurate codes to encounters based upon provider responses to queries and reports queries and responses IAW DHA guidance
• Acts as a source of reference to medical staff that have questions, issues, or concerns related to coding. Responds to provider questions and provides examples of appropriate coding and documentation reference(s) to provide clarity and understanding. Based on contacts from the medical staff, identifies training opportunities and works with coding training personnel to focus on consistency and clarity of coding advice provided. Collaborates with Medical Coding Trainers in developing, delivering, and monitoring initial and annual coding training to providers and clinical staff by providing guidance to professional and technical staff in documentation requirements for coding
• Supports DHA coding compliance by performing due diligence in ethically and appropriately researching and/or interpreting existing guidance, including seeking clarification from the Lead Medical Coder, supervisor, or DHA-MCPB. Performs administrative related tasks associated with medical records final reviews/audits and contacting various departments, services, or medical staff to obtain data needed to complete the records. Complies with DHA coding compliance requirements regarding training and reporting of potential violations.
• Coding backlog support to be determined.
• Provides or contributes to periodic reports IAW DHA MCPB instructions and timelines.

During the application process, you will be required to upload the following documents. Please ensure that they are up to date, complete, and ready for upload.

• Resume (must list at least 2 areas of specialty coding for each job location where coding was performed)
• OF306
• Documents proving your U.S. Citizenship
• A copy of your coding certifications
• A copy of your AAPC/AHIMA membership car