Medical Coder III

Job Description

Description

• 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). 
• Practical 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.
•  Advanced knowledge of medical specialties; medical diagnostic and therapeutic procedures; ancillary services (includes, but is not limited to, Laboratory, Occupational Therapy, Physical Therapy, and Radiology). 
• Thorough 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.
• Practical knowledge of revenue cycle management, project management concepts, business analysis, training methods, clinical documentation improvement, and continuous process improvement processes. 

Qualifications

• Minimum of 5 years of medical coding and/or auditing experience in 2 or more medical, surgical and ancillary specialties within the past 10 years. Required experience must include Medical Severity - Diagnostic Related Group (MS-DRG) assignment.
• Minimum of one (1) year of performance in the specialty is required to be qualifying. Multiple specialties encompass different medical specialties (i.e. Family Practice, Pediatrics, Gastroenterology, OB/GYN, etc.) that utilize ICD, E&M, CPT, and HCPCS codes. Ancillary specialties (PT/OT, Radiology, Lab, Nutrition, etc.) that usually do NOT use E&M codes do not count as qualifying experience. Additionally, coding, auditing and training exclusively for specialties such as home health, skilled nursing facilities, and rehabilitation care will not be considered as qualifying experience.
• Coding experience limited to making codes conform to specific payer requirements for the business office (insurance billing, accounts receivable) is not a qualifying factor
• At least 30 semester hours’ university/college credit that includes relevant coursework such as anatomy/physiology, medical terminology, health information management, and/or pharmacology.  
• Successful completion of Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) coding exam preparation courses that include the above coursework & lead to successful course completion & coding certification may be accepted in lieu of university/college credit by the AFMS MCPO
   
• Certification in good standing for each:

  1. RHIT/RHIA/CPC/CCS-P
  2. RHIT/RHIA/CIC/CCS
  3. CEMA/CPMA
  * The AHIMA RHIT or RHIA credential may be counted toward 1. Or 2.  but not both unless the individual possesses the required institutional AND professional services experience for the specific position sought.

• Selected applicant must do the following before starting, based on government requirements:       
  • Pass a pre-employment coding test IAW the requirements of the AFMS Coding Manual. 
  • Provide proof of specific vaccinations and CPR training that is required to work at the facility
  • The selected applicant will be subject to a government security investigation and must meet eligibility requirements

Overview

SAIC® is a premier Fortune 500® technology integrator driving our nation's technology transformation. Our robust portfolio of offerings across the defense, space, civilian, and intelligence markets includes secure high-end solutions in engineering, digital, artificial intelligence, and mission solutions. Using our expertise and understanding of existing and emerging technologies, we integrate the best components from our own portfolio and our partner ecosystem to deliver innovative, effective, and efficient solutions that are critical to achieving our customers' missions.

We are approximately 26,000 strong; driven by mission, united by purpose, and inspired by opportunities. SAIC is an Equal Opportunity Employer, fostering a culture of diversity, equity, and inclusion, which is core to our values and important to attract and retain exceptional talent. Headquartered in Reston, Virginia, SAIC has annual revenues of approximately $7.4 billion. For more information, visit saic.com. For ongoing news, please visit our newsroom.