Ambulatory Procedure Visit-Outpatient Coder

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• Ambulatory Procedure Visit-Outpatient Coder
  
  

Ambulatory Procedure Visit-Outpatient Coder

COMPANY OVERVIEW: Health Partners Management Group, Inc (HPMG) is a government contracting company in Poplar Bluff, Missouri. HPMG currently has a contract with the Federal Government. You would be a W-2 employee for HPMG and NOT a government employee.

SUMMARY: 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. Trains and educates MTF staff on coding issues and plays a significant role in departmental and clinic-wide coding compliance activities.

Mandatory Knowledge And Skills

• Position requires excellent computer/communication skills for provider and staff interactions.
• Knowledge of anatomy/physiology and disease process, medical terminology, coding guidelines (outpatient and ambulatory surgery), documentation requirements, familiarity with medications and reimbursement guidelines; and encoder experience.
• Candidate must have ability to handle multiple projects and appropriately prioritize tasks to meet deadlines.
  
  

Other Knowledge, Skills, And 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 reports.
• Practical knowledge of clinical documentation improvement and continuous process improvement processes.
• Practical knowledge of EHR systems and workflows pertaining to medical coding.
  
  

EDUCATION/CERTIFICATION: The following are recognized certifications: Registered Health Information Technologist (RHIT) or Registered Health Information Administrator (RHIA), Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Coder Specialist (CCS), Certified Coder Specialist – Physician (CCS-P) are preferred for outpatient/ambulatory surgery medical coders.

A Registered Health Information Technician (RHIT) and Registered Health Information Administrator (RHIA) from AHIMA 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.

The E&M coding certifications requirement for a Certified Evaluation and Management Coder (CEMC), or National Alliance of Medical Auditing Specialists’ (NAMAS) Certified Evaluation and Management Auditor (CEMA), are waived for personnel in this contract.

Coding certifications other than those listed will be considered by the government on a case-by-case basis.

CONTINUED EDUCATION REQUIREMENTS: Medical coders will obtain the required continued education hours to maintain the current and proper national certification(s) required for the position.

EXPERIENCE: Coding personnel in this position are required to possess 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; OR a minimum of two (2) years of medical coding or auditing experience if that experience was in an MTF. A minimum of one (1) year of performance in the specialty is required to be documented to be considered qualifying.

Performance Outcomes

• Responsible for assignment of accurate E&M, ICD, CPT and HCPCS codes and modifiers from medical record documentation into the Government computer systems.
• 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.
• Works closely with the Coding Supervisor/auditor during audit process.
• Ensures all required component parts of the medical record that pertain to coding are present, accurate and compile with DoD and JCAHO requirements.
• Works with Coding Compliance-Editor software to ensure records are accurately coded.
• Accurately assigns diagnosis and procedure codes for facility and professional services for Day Surgery (a.k.a. Ambulatory Procedure Visit (APV)), Dental surgical procedures, Observation, Emergency Department (ED), outpatient ERSA, outpatient procedures, outpatient specialty encounters, and any outpatient primary care encounters billable to a third party IAW DHA accuracy, completeness, productivity, and timeliness standards contained in DoDI 6040.42, Management Standards for Coding of DoD Health Records. 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 include, but not limited to, 3M Encompass 360, Joint Legacy Viewer (JLV)) to complete encounters. Researches and resolves coding edit failures as assigned.
• Adheres to accepted coding DHA and industry 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 courses, webinars, and other learning opportunities IAW AAPC and AHIMA CEU requirements for maintaining the coding certifications required for the position.
• 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 medical provider’s attention.
• When necessary, develops and submits a written (electronic or hard copy) query IAW DHA Coding Compliance Plan 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. Assigns accurate codes to encounters based upon provider responses to queries and reports queries and responses IAW DHA Coding Compliance Plan.
• Supports DHA coding compliance by performing due diligence in ethically and appropriately researching and/or interpreting existing guidance, including seeking clarification from the contractor supervisor or DHN Pacific Rim.
• Reviews and resolves coding edit failures in MHS GENESIS®.
  
  

Unique Military Health Care Systems/Procedures

• Composite Health Care systems (CHCS) and/or MHS GENESIS
• Armed Forces Health Longitudinal Technology Application (AHLTA). An electronic medical record documentation system designed for the MHS;
• Defense Enrollment Eligibility Reporting System (DEERS);
• Military Filing System - by sponsor social security number, terminal digit order, color-coded and blocked filing system.
• Contents of a military medical record, layout, sections, family member prefix designation, forms used in a MTF, and the medical record tracking procedures.
• EssentrisTM, the client-server version of the Clinical Information System (CIS)
• Coding Compliance Editor (CCE) Systems
• Biometric Data Quality Assurance Service (BDQAS)
• MHS Coding Guidelines http://www.tricare.mil/ocfo/bea/ubu/coding_guidelines.cfm
  
  

WORK ENVIRONMENT/PHYSICAL REQUIREMENTS: The work is primarily sedentary. Requirements may include prolonged walking, standing, sitting or bending. Carrying or lifting medical records may be required daily. Use of one or more computer programs and monitors may be required daily.

Benefits

• Paid time off
• Sick time
• Eleven (11) paid holidays
• $20,000 company paid life insurance policy
• Medical insurance (employee only coverage)
• Dental, vision and voluntary life insurance (optional)
• Retirement plan
• Critical illness and accident policies (provided through section 125 tax credits for qualifying employees)
  
  

If you're ready to contribute your skills to a dedicated team focused on enhancing healthcare services, we invite you to apply today with Health Partners Management Group, Inc.

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