Lead Medical Coder III

Job Description

Description

SAIC is looking to hire a Lead Medical Coder III to support our medical coding efforts at AFMOA in San Antonio, TX. The primary duties are to act as liaison between contractor management staff and the Government, and will have supervisory authority over the other Medical Coder III contract personnel performing under this contract.  The Lead Medical Coder III will work with contractor management staff and the Government in design, execution, and monitoring of training or individual development plans of assigned Medical Coder III personnel under this contract.  In addition, he/she will be expected to  review clinical documentation and assign medical codes for inpatient facility and/or professional services; however, Medical Coder III personnel may be tasked to assign medical codes for facility and/or professional services for ambulatory surgery, observation, emergency department, or outpatient clinic services.

Qualifications:

• 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).
• 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, Occupational Therapy, Physical Therapy, and Radiology); and revenue cycle management concepts.
• 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 is 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 revenue cycle management, project management concepts, business analysis, training methods, clinical documentation improvement, and continuous process improvement processes.
• Practical knowledge of Current Dental Terminology (CDT).

Qualifications

Position Requirements

• Lead Medical Coder III is expected to possess, out of the required coding experience, a minimum of 2 years of experience that includes performance of lead or supervisory tasks.
• A minimum of five (5) years of medical coding and/or auditing experience in four or more medical, surgical, and ancillary specialties within the past fifteen (15) years.
• A 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. Coding experience should include inpatient facility and ambulatory surgery areas. 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.

**** Medical coding personnel shall maintain the required continuing education hours in order to maintain current and proper national certification (requirements for this position.

Coding certifications in good standing for each of the following is preferred. However, SAIC will consider applicants who have at least ONE of the certifications  and are willing to obtain additional certifications.

1. RHIT or RHIA or CPC or CCS-P

2. RHIT or RHIA or CIC or CCS

3.  CEMA or CEMC

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.