Medical Coder

Dutch Ridge Consulting Group•,

3d•Remote

About The Position

Dutch Ridge Consulting Group, LLC (DRCG) is seeking a highly motivated Medical Coder to support a federal client. The Medical Coder is responsible for performing remote coding and will use skills, training, and knowledge of International Classification of Diseases, Current Procedural Terminology, and Healthcare Common Procedure Coding System Level II code sets and guidelines and other generally accepted available resources to review health record documentation and providers' scope of practice to assign diagnostic and procedural codes. The Medical Coder will code Outpatient Encounters including Radiology, Lab, or other Ancillary Services, and include the required encoder/HER data elements in accordance with Veterans Health Administration (VHA) Handbooks. Other identified cases to be coded include, but not limited to, Veteran Tortfeasor Claims, Veteran Workers' Compensation, Humanitarians, beneficiaries of the Military Health System (TRICARE), Civilian Health and Medical Program of the Department of Veterans Affairs, Ineligibles, Fugitive Felon, Prosthetics, non-Veterans Affairs Fee Services, and New Insurance/Late Checkout. Perform remote coding on all inpatient/ outpatient visits and surgical procedures by VA Health Care System (VAHCS). They access VA's VistA/CPRS system to read and code medical records identified by VA and enter codes into the approved encoder or other package. The Medical Coder is required to comply with all HIPAA provisions for a Business Associate, and all provisions in this Performance Work Statement.

Requirements

Formal training in anatomy and physiology, medical terminology, pathology and disease processed, pharmacology, health record format and content, reimbursement methodologies and conventions, rules and guidelines for current classification systems (ICD, CPT, HCPCS, E&M, etc.).
Experience with the Evaluation and Management (E/M) guidelines applicable to the date of service.
Experience and proficiency in 1995 and 1997 E/M documentation guidelines for legacy and retrospective encounters and 2021 and 2023 E/M guidelines for current encounters.
Experience with ensuring coding accuracy and compliance with VA, CPT, and CMS aligned standards, particularly for retrospective coding and accounts referred by billing.
Minimum of Two (2) years' experience in outpatient coding.
Must be credentialed and have completed an accredited program for coding certification, an accredited health information management or health information technician.
A certified coder is someone credentialed by the: American Health Information Management Association (AHIMA) and includes RHIA, RHIT, CCS and CCS-P, or American Academy of Professional Coders (AAPC) as a CPC or CPC-H.
Knowledge and familiarity with the VHA national encoder, industry standard guidelines, VHA and local policies, and other generally accepted reference materials to assign and/or validate diagnostic and procedure codes reflective of documentation.

Responsibilities

Performing remote coding using International Classification of Diseases, Current Procedural Terminology, and Healthcare Common Procedure Coding System Level II code sets and guidelines.
Reviewing health record documentation and providers' scope of practice to assign diagnostic and procedural codes.
Coding Outpatient Encounters including Radiology, Lab, or other Ancillary Services.
Including required encoder/HER data elements in accordance with Veterans Health Administration (VHA) Handbooks.
Coding various identified cases including Veteran Tortfeasor Claims, Veteran Workers' Compensation, Humanitarians, beneficiaries of the Military Health System (TRICARE), Civilian Health and Medical Program of the Department of Veterans Affairs, Ineligibles, Fugitive Felon, Prosthetics, non-Veterans Affairs Fee Services, and New Insurance/Late Checkout.
Performing remote coding on all inpatient/ outpatient visits and surgical procedures by VA Health Care System (VAHCS).
Accessing VA's VistA/CPRS system to read and code medical records.
Entering codes into the approved encoder or other package.
Complying with all HIPAA provisions for a Business Associate.
Being qualified and competent to perform coding services and activities.
Maintaining a minimum of 95% accuracy rate on all auditing scores.
Completing coding activities within five (5) calendar days from assignment.
Abstracting other identified data items and entering the data into the local EHR encoder program.
Utilizing standardized reasons in the encoder application to communicate specific document information to Billing.
Utilizing the national encoder product and EHR, if necessary, to reflect code changes and name(s) of provider(s).
Reading and reviewing documentation in the electronic health record.
Completing data entry into the encoder.
Providing input to weekly, monthly, and quarterly reports.
Complying with all VA privacy and security requirements.
Applying GR, G8, QK, QX, QS, QY, and G9 modifiers correctly.
Applying knowledge of current Diagnostic Coding and Reporting Guidelines for outpatient services.
Applying knowledge of CPT format, guidelines, and notes to locate the correct codes for all services and procedures performed during the encounter/visit and sequencing them correctly.
Applying knowledge of procedural terminology to recognize when an unlisted procedure code must be used in CPT.
Coding in accordance with Correct Coding Initiative (CCI) Bundling Guidelines.
Using the CMS Common Procedural Coding Systems (HCPCS), where appropriate.
Coding inpatient discharges when requested by VHA.
Completing the yearly privacy and security processes and training as required by the VAHCS.