SAIC is looking to hire a Medical Coder III to support our medical coding efforts at AFMOA in San Antonio, TX. The primary are 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.
Knowledge and Skills:
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.
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:
Professional Services Coding Certifications: Registered Health Information Technician (RHIT); Registered Health Information Administrator (RHIA); Certified Professional Medical Coding Auditor (CPMA); Certified Professional Coder (CPC); Certified Outpatient Coder (COC); or Certified Coding Specialist - Physician (CCS-P).
Continuing Education Requirements: Medical coders shall maintain the required continuing education hours in order to maintain current & proper national certification(s) requirements for this position at no expense to the Government
Institutional (Facility) Coding Certifications: Certified Inpatient Coder (CIC), Certified Coding Specialist (CCS). Other institutional coding certifications will be considered by the AFMS MCPO on a case-by-case basis.
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