Medical Coding Modernization Specialist

AAI•Pearl Harbor, HI

About The Position

AAI is actively recruiting a Medical Coding Modernization Specialist. This 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.

Requirements

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, ResourceBased 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.
Medical Coding Modernization Specialists will maintain the required continuing education hours and credentials as required by their national association certification at their own expense.
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. 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.
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.
UNIQUE MILITARY HEALTH CARE DYDTEMD/PROCEDURED: Armed Forces Health Longitudinal Technology Application (AHLTA). Composite Health Care System (CHCS) and/or MHS GENESIS. Defense Enrollment Eligibility Reporting System (DEERS). Essentris™ The client-server version of the Clinical Information System (CIS). Coding Compliance Editor (CCE). Biometric Data Quality Assurance Service (BDQAS)- https://bdqas.afms.mil/ AFMS Internal Coding Audit Methodology – AFMOA Audit Tool/Coding Audit Review System (CARS), or current tool. MHS Coding Guidelines http://www.tricare.mil/ocfo/bea/ubu/coding_guidelines.cfm AFMS Centralized Coding Manual.

Responsibilities

Assists the MTF in identifying medical coding deficiencies by analyzing documentation and coding practices that may be misrepresenting or incorrectly capturing medical care activities.
Analyzes historical encounter documentation and coding records from Government computer systems and medical records to identify clinical documentation improvement (CDI) and training opportunities.
Compares documentation to code application to ensure accuracy.
Tracks deficiencies for trending and corrective action.
Collaborates with MTF leadership, MTF providers/staff, and other coding professionals related to the performance of tasks to address recurring documentation and coding deficiencies, Contacts providers to review findings to improve documentation practices as well as E&M leveling, capturing medical procedures and to improve diagnosis specificity issues IAW with coding guidelines.
Develops focused training presentations from thorough analysis as outlined in the MTF modernization action plan.
Seeks Government approval prior to delivering Government scheduled training to MTF providers and other staff.
Creates and submits training activity reports to the MTF leadership.
Presents reports to the Government weekly and identifies scheduling issues and obstacles to meeting improvement objectives.
Creates monthly reports showing completed activities and improvement to metrics