Medical Coding Trainer/Inpatient Coding Auditor

WORKPLACE FOR THE POSITION IS HYBRID--ONSITE AND TELEWORK

Medical Coding Trainer:

SUMMARY: Develops specific goals and designs/organizes effective training presentations to promote coding and documentation improvement. Trains and educates MTF staff on coding issues and plays a significant role in coding compliance activities. Delivers appropriate and effective feedback and training via phone, email, virtual/webinar software, and face-to-face methods, according to customer needs and in accordance with (IAW) policy. This individual will track, monitor and report audits and training activities and results.

Inpatient Medical Coding Auditor:

SUMMARY: Responsible for the auditing of medical documentation and codes for compliance with federal coding regulations and guidelines. This will include review of the current ICD coding classification for diagnosis and procedures and the validity of the Medical Severity-Diagnosis Related Group (MS-DRG) assignments. The inpatient auditor is responsible for the auditing of medical documentation and codes for inpatient professional services or Rounds. The Rounds encounters 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.

Qualifications

Mandatory Knowledge and Skills

•    Excellent verbal/written communication skills for provider and staff interactions.

•    Advanced knowledge and understanding of Evaluation and Management (E&M) codes, International Classification of Diseases (ICD) diagnoses, current procedural terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS), and modifiers.

•    Advanced understanding of medical terminology, pharmacology, body systems/ anatomy, physiology and concepts of disease processes.

•    Knowledge of legal, regulatory, and policy compliance issues related to medical coding and documentation and current and developing issues and trends in medical coding procedures requirements.

•    Detailed knowledge of medical coding systems, procedures, and documentation requirements and the ability to adapt and modify medical coding procedures, protocol, and data management systems to meet specific operating requirements.

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

•    Advanced knowledge of auditing concepts and principles. 

•    Ability to handle multiple projects and appropriately prioritize tasks to meet deadlines.

•    Demonstrated ability to analyze coder comments and audit results, and research Military Health System (MHS), DoD or Service level requirements, and Center for Medicare and Medicaid Services (CMS) coding guidelines for compliance.

•    Knowledge and understanding of medical coding and reimbursement guidelines.

•    Attention to detail and completeness with a thorough understanding of government rules and regulations, and potential areas of risk for fraud.

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

Education

A minimum of one of the following: An associate degree in health information management OR a university certificate for medical coding, OR at least 30 semester hours university/college credit that includes relevant coursework such as anatomy/physiology, medical terminology, health information management, and/or pharmacology. Education must be from an accredited educational institution recognized by the American Health Information Management Association (AHIMA) and/or American Academy of Professional Coders (AAPC).

Certifications

The following are recognized professional certifications: Registered Health Information Technician (RHIT); Registered Health Information Administrator (RHIA); Certified Professional Medical Auditor (CPMA); Certified Professional Coder (CPC); Certified Outpatient Coder (COC), Certified Inpatient Coder (CIC), Certified Coding Specialist (CCS); or Certified Coding Specialist – Physician (CCS-P).

The required continuing education hours must be met in order to maintain current and proper national certification(s) requirements for this position at no expense to the government.

Experience

A minimum of eight years of medical coding and/or auditing experience, with minimum 5 years of inpatient coding experience,  in two or more medical, surgical and ancillary specialties.  A minimum of one (1) year of performance in the specialty is required to be qualifying AND four