SUMMARY : Responsible for the auditing of medical documentation and codes for compliance with federal coding regulations and guidelines. This will include the assignment of ICD, Current Procedure Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) codes, modifiers, and quantities as documented by the physician. Trains and educates MTF staff on coding issues and plays a significant role in coding compliance activities.

1. QUALIFICATIONS:

1.1. Mandatory knowledge and skills.

1.1.1. Knowledge of auditing concepts and principles.

1.1.2. Advanced knowledge of medical coding and billing systems and regulatory requirements.

1.1.3. Strong communication and interpersonal skills.

1.1.4. Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation.

1.1.5. Knowledge of current and developing issues and trends in medical coding procedures requirements.

1.1.6. Detailed knowledge of medical coding systems, procedures, and documentation requirements.

1.1.7. Ability to adapt and modify medical billing procedures, protocol, and data management systems to meet specific operating requirements.

1.1.8. Ability to clearly communicate medical information to professional practitioners and/or the general public.

1.1.9. Ability to use independent judgment and to manage and impart confidential information.

1.1.10. Ability to analyze and solve problems.

1.1.11. Ability to provide guidance and training to professional and technical staff in area of expertise.

1.1.12. Computer literate, with knowledge of coding and auditing packages, mainframe and office software applications.

1.1.13. Knowledge of medical ethics, telephone etiquette, and customer service

1.2. Education/Certification.

1.2.1. Ambulatory Auditor Certifications. Registered Health Information Technologist (RHIT), Registered Health Information Administrator (RHIA), Certified Professional Coder (CPC), Certified Professional Coder-Hospital (CPC-H), Certified Coder Specialist-Physician (CCS-P), and/or Certified Coder Specialist (CCS) are acceptable with a minimum of 5 years medical coding experience (encompassing multiple clinical specialties) and 3 years of medical auditing experience within the last eight years is required. The candidates possessing a Certified Professional Medical Auditor (CPMA) certification must have a minimum of 2 years medical auditing experience within the last 5 years of medical coding experience (encompassing multiple clinical specialties).

1.2.3. CONTINUED EDUCATION REQUIREMENTS: Contract medical coders will obtain the required continuing education hours at no expense to the government in order to maintain current and proper national certification(s) required for the position.

1.3. Experience. A minimum of 5 years medical coding experience in multiple clinical specialties and three years of medical auditing experience within the last eight years is required. Expertise must also include ambulatory surgery coding/auditing for the outpatient auditor reviewing APV encounters.

1.4. Work Environment/Physical Requirements. The work is primarily sedentary. Requirements include prolonged walking, standing, sitting or bending. Carrying or lifting of medical records is usually required daily. Use of one or more computer programs and monitors may be required to efficiently accomplish duties.

2. UNIQUE MILITARY HEALTH CARE SYSTEMS/PROCEDURES:

2.1. Armed Forces Health Longitudinal Technology Application (AHLTA)

2.2. Composite Health Care systems (CHCS) and/or MHS GENESIS

2.3. Defense Enrollment Eligibility Reporting System (DEERS);

2.4. Military Filing System - by sponsor social security number, terminal digit order, color-coded and blocked filing system.

2.5. Contents of a military medical record, layout, sections, family member prefix designation, forms used in a MTF, and the medical record tracking procedures.

2.6. EssentrisTM, the client-server version of the Clinical Information System (CIS)

2.7. Coding Compliance Editor (CCE) Systems

2.8. Biometric Data Quality Assurance Service (BDQAS).

2.9. MHS Coding Guidelines http://www.tricare.mil/ocfo/bea/ubu/coding_guidelines.cfm

Proof of immunizations, including COVID vaccination, and physical are required. Some immunizations, such as flu vaccine, required annually.

Must obtain government security clearance. US citizenship is a requirement for the clearance.

This contractor and subcontractor shall abide by the requirements of 41 CFR 60-1.4(a), 60-300.5(a) and 60-741.5(a). These regulations prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, sexual orientation, gender identity or national origin. Moreover, these regulations require that covered prime contractors and subcontractors take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.