Medical Coding Compliance Specialist ONSITE

Medical Coding Compliance Specialist

(Medical Auditor)

POSITION IS HYBRID -- DAYS ONSITE AT NMCCL, JACKSONVILLE, NC and REMOTE

SUMMARY: Member of the MHS agency Coding Program Office support team. The position will reduce inpatient facility, ambulatory procedure visit (APV), or professional services coding (PSC) backlog created by workload surges, manning shortages, or computer system issues. This position will conduct focused audits for coding compliance or training purposes; develop standardized coding training; deliver coding education/training to individuals or groups; and identifying/educating on clinical documentation improvement opportunities.

Mandatory Knowledge and Skills

1) Knowledge of The International Classification of Diseases, Ninth Revision, Clinical Modification (ICDCM), procedural coding, healthcare common procedure coding system (HCPCS)/current procedural terminology (CPT) nomenclature, medical and procedural terminology, anatomy and physiology, pharmacology, and disease processes to perform the duties described. 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).

2) Knowledge of and the ability to interpret guidelines, rules and regulations developed by: Centers for Medicare & Medicaid Services (CMS), American Medical Association (AMA), American Heart Association (AHA) and other applicable Federal requirements so as to provide timely and accurate information relating to coding, billing and documentation.

3) Excellent oral and written communication skills, interpersonal skills along with the confidence to present complex medical coding issues and educational instruction to a diverse audience. Must be comfortable in front of high ranking, professional staff and coding peers to training and respond to questions.

4) Ability to write reports, business correspondence, and procedure manuals.

5) Organizational, analytical, time management, statistical, and problem solving skills.

6) Advanced knowledge of computers, keyboard skills, and various software programs including Microsoft (word processing, spreadsheet and database) as well as coding software programs

EDUCATION

At least one of the following recognized professional coding certifications from AHIMA and or AAPC is required: Registered Health Information Technician (RHIT); Registered Health Information Administrator (RHIA); Certified Professional Medical Auditor (CPMA); Certified Professional Coder (CPC); Certified Outpatient Coder (COC);Certified Coding Specialist (CCS); or Certified Coding Specialist – Physician (CCS-P).

EXPERIENCE

A minimum of ten years of medical coding experience within the past ten years, in more than 4 medical and surgical specialties. A minimum of two years of inpatient facility coding experience must be included in the required ten years of experience. A minimum of two years of ambulatory surgery facility coding experience must be included in the required ten years of experience. 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.

 AND A minimum of four years of auditing, training, and/or compliance functions within the last ten years is required. 

OR Candidates with three years of auditing, compliance, or training experience involving professional and facility coding within the last five years in a DoD coding environment may be considered in lieu of ten years for those without DoD experience.

• Auditing functions include development and execution of audit plan, conducting audit according to audit plan by reviewing required documentation and determining compliance with audit standards, communicating with stakeholders during all phases of audit, and reporting on audit findings.
• Training functions include identifying coding training opportunities; developing coding training plans, and development/delivery of coding training to coder and physician/provider audiences.
•  Compliance functions include identifying compliance issues and analyzing practice patterns and recommending changes to policies and procedures; recommending/updating standard policies and procedures; contribute to risk assessments and mitigation strategies; and data collection and statistical report generation.

Experience within MTF is desirable.  MHS GENESIS EXPERIENCE is desireable.

Requires some occasional local travel.

Physical and proof of immunizations, including COVID Vaccinations, flu and TB assessment required.

Security clearance necessary to start to work.  US Citizenship is a requirement for a security clearance.

This contractor and subcontractor shall abide by the requirements of 41 CFR 60-1.4(a), 60-300.5(a) and 60-741.5(a). These regulations prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, sexual orientation, gender identity or national origin. Moreover, these regulations require that covered prime contractors and subcontractors take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.