Medical Ambulatory Coder

COHO Integrated Solutions is seeking an experienced Medical Ambulatory Coder to support the Defense Health Agency Medical Coding Program Branch (DHA-MCPB) as well as the Continental Defense Health Network (DHN). This position is fully remote. In this important role, you’ll help to improve the accuracy and quality of medical coding and documentation across DHA in support of the DHA mission. 

Responsibilities (include but are not limited to):

• Advanced knowledge of the International Classification of Diseases, Clinical Modification (ICD-CM), and Procedural Coding System (PCS); 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) and Diagnostic Related Groupings (DRGs); 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.

• 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.

• Work may involve areas such as Laboratory, Radiology, and Dental services.

• Researches and resolves coding edit failures as assigned.

• Reviews and resolves coding edit failures in MHS GENESIS.

Essential Job Requirements:

• Citizenship:
  • Proof of US Citizenship is required to work on this contract.

• Education/Certifications:
  • 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.
  • Contract employees must achieve a minimum 80% passing score on Government provided test.

• Required Knowledge/Experience:
  • 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 a Military Treatment Facility (MTF).
  • A minimum of one (1) year of performance in the specialty is required to be documented to be considered qualifying.

Position Pay Range$24—$29 USD

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