Outpatient Medical Coder/Auditor (28004)

LTSi•Quantico, VA

12h•Onsite

About The Position

Laredo Technical Services, Inc. is hiring a full-time, on-site Outpatient Medical Coder/Auditor for Naval Health Clinic Quantico. The position is scheduled Monday through Friday, 7:30 a.m. to 4:30 p.m., excluding Federal Holidays, with an immediate start upon completion of background and security investigations. The coder/auditor assigns and validates diagnosis, procedure, and supply codes for professional and institutional components of outpatient encounters in accordance with Defense Health Agency (DHA) and Air Force Medical Service Medical Coding Program Office (AFMS MCPO) standards. The role reviews records and documentation, raises queries when provider documentation is unclear or incomplete, supports coding compliance, and provides coding guidance and education to providers and clinical staff. The position may also conduct focused audits and reviews, help prepare reports, correct coding-related write-back errors, and support other military treatment facilities (MTFs) when directed. Candidates must hold current coding credentials in good standing, including a recognized professional services coding certification and a NAMAS Certified Evaluation and Management Auditor (CEMA) certification. The job requires recent medical coding and/or auditing experience across multiple specialties and practical knowledge of coding systems, reimbursement methods, medical terminology, clinical subjects, and revenue cycle management. An associate degree or other qualifying coding education is desired.

Requirements

Hold current coding certifications in good standing from each required category: Certified Professional Coder (CPC) or Certified Coding Specialist–Physician (CCS-P), and NAMAS Certified Evaluation and Management Auditor (CEMA).
Have at least three years of medical coding and/or auditing experience in two or more medical, surgical, and ancillary specialties within the past 10 years; at least one year of performance in the specialty is required.
Have practical knowledge of ICD-CM, HCPCS, and CPT.
Have practical knowledge of reimbursement systems, including Ambulatory Payment Classifications (APCs) and Resource-Based Relative Value Scale (RBRVS).
Have practical knowledge of industry nomenclature, medical and procedural terminology, anatomy and physiology, pharmacology, and disease processes.
Have practical knowledge of medical specialties, diagnostic and therapeutic procedures, ancillary services, and revenue cycle management.

Nice To Haves

An associate degree in Health Information Management.
A university certificate in medical coding.
At least 30 semester hours of university or college credit, including relevant coursework such as anatomy and physiology, medical terminology, health information management, or pharmacology.
Successful completion of an AAPC or AHIMA coding certification preparation course for professional services or facility coding that includes medical terminology, anatomy and physiology, health information management concepts, and pharmacology.
RHIT or RHIA credentials, which count as a coding certification for professional services or institutional coding.

Responsibilities

Assign diagnosis, procedure, and supply codes for professional and institutional components of outpatient encounters in accordance with DHA and AFMS MCPO standards for completeness, productivity, and timeliness.
Follow accepted coding practices, guidelines, and conventions to select appropriate codes and ensure ethical, accurate, and complete coding.
Monitor regulatory and policy requirements affecting coded information across the services provided.
Review encounter and record documentation for inconsistencies, ambiguities, discrepancies, legibility issues, and other documentation concerns; bring issues to providers’ attention.
Examine records for proper document sequence, authorized signatures, and sufficient information supporting diagnoses, treatment, and results, as applicable.
Submit written queries to providers when documentation is conflicting, ambiguous, or incomplete; track query submission, response times, and completion.
Educate providers and clinical staff and provide feedback to resolve documentation issues and support coding compliance.
Assign codes based on provider responses to queries and report queries and responses in accordance with DHA or AFMS MCPO guidance.
Answer medical staff questions about coding and provide appropriate coding and documentation references.
Identify training opportunities and collaborate with coding training personnel to improve consistency and clarity of coding advice.
Collaborate with Medical Coding Trainers on initial and annual coding training for providers and clinical staff.
Research and interpret coding guidance, seeking clarification from the Lead Medical Coder, supervisor, or Service coding representatives as needed.
Conduct focused audits of MTFs, specialties, clinics, coders, or providers, as directed, and perform QA or peer reviews in accordance with DHA or AFMS MCPO requirements.
Perform administrative tasks associated with medical record final reviews and audits, including contacting departments, services, or medical staff to obtain needed information.
Comply with coding compliance training and reporting requirements, and assist with MTF training and training tracking as needed.
Correct coding-related write-back errors and track corrective action as applicable.
Use MHS computer systems to access patient records remotely and code encounters for other MTFs when directed by DHA or AFMS MCPO.
Review coding validation notifications, verify identified diagnosis codes, make corrections when necessary, and ensure encounters are corrected within three business days; provide provider training on the consequences of code use.
Provide or contribute to periodic reports in accordance with DHA and AFMS MCPO instructions and timelines.
Provide limited assistance to MTF Data Quality, Group Practice Managers, or other MTF business functions with compiling, analyzing, and reporting coding data for performance purposes.