Medical Coder, Ambulatory Procedure Visit (APV)

Title: Medical Coder, Ambulatory Procedure Visit (APV)

Location: Lackland AFB, onsite, 78236

Status: Full-time

Lewis Price and Associates is currently seeking Medical Coders for our client. The position will be located at Lackland AFB.

Overview:

The primary duties of an Ambulatory procedure visit medical coder are to review clinical documentation and assign medical codes for ambulatory surgery, observation, Emergency Department, and outpatient specialty facility and/or professional services; however, Ambulatory procedure visit medical coder personnel may be tasked to assign medical codes for facility and/or professional services for Outpatient Primary Care services.

Responsibilities:

• Accurately assigns diagnosis, procedure, and supply codes for the professional and institutional ambulatory External Resource Sharing Agreement (ERSA), Ambulatory Procedure Visit (APV), Observation, Emergency Department (ED), and Outpatient encounters. Codes assigned include International Classification of Diseases, Clinical Modification (ICD-CM), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and modifiers IAW DHA and AFMS MCPO completeness, productivity, and timeliness standards.
• Uses military computer systems to assign, edit, and review codes. Applies knowledge of medical terminology, anatomy and physiology, disease processes, treatment modalities, diagnostic tests, medications, procedures as well as the principles and practices of health services and the organizational structure to ensure proper code selection.
• Adheres to accepted coding practices, guidelines and conventions when choosing the most appropriate diagnosis, operation, procedure, ancillary, or Evaluation and Management code to ensure ethical, accurate, and complete coding.
• Monitors ever-changing regulatory and policy requirements affecting coded information for the full spectrum of services provided.
• Maintains technical currency through continuing education and training opportunities.
• Reviews encounter and/or record documentation to identify inconsistencies, ambiguities, or discrepancies that may cause inaccurate coding, medico-legal re-percussions or impacts quality patient care. Identifies any problems with legibility, abbreviations, etc., and brings to the provider’s attention. May perform assessments and examine records for proper sequence of documents, presence of authorized signatures, and sufficient data is documented that supports diagnosis, treatment administered, and results obtained.
• Develops and submits a written (electronic or hard copy) query IAW DHA or AFMS MCPO guidelines to the provider to request clarification of provider documentation that is conflicting, ambiguous, or incomplete in regards to any significant reportable condition or procedure.
• Monitors query submission, response times, and completion.
• Educates and provides feedback to providers and clinical staff to resolve documentation issues to support coding compliance. Assigns 28 accurate codes to encounters based upon provider responses to queries and reports queries and responses IAW DHA or AFMS MCPO guidance.
• Acts as a source of reference to medical staff having questions, issues, or concerns related to coding. Responds to provider questions and provides examples of appropriate coding and documentation reference(s) to provide clarity and understanding. Based on contacts from the medical staff identifies training opportunities and works with coding training personnel to focus on consistency and clarity of coding advice provided. Collaborates with Medical Coding Trainers in developing, delivering, and monitoring initial and annual coding training to providers and clinical staff by providing guidance to professional and technical staff in documentation requirements for coding.
• Supports DHA and AFMS coding compliance by performing due diligence in ethically and appropriately researching and/or interpreting existing guidance, including seeking clarification from the Lead Medical Coder, supervisor, or Service coding representatives. May perform focused audits of specific MTFs, medical specialties, clinics, coders, or providers as directed and IAW DHA and/or AFMS audit procedures. Performs administrative related tasks associated with medical records final reviews/audits and contacting various departments, services, or medical staff to obtain data needed to complete the records. Maintains confidentiality and privacy of medical, personal, and sensitive information in compliance with the Health Insurance Portability and Accountability Act. Complies with DHA and/or AFMS coding compliance requirements regarding training and reporting of potential violations. May assist with MTF
• System Edit Error Correction. The entry and transmittal of patient and coding data through different Government computer systems will sometimes be flagged for errors (known as “write-back errors”). Write-back errors are corrected by the MTF staff or coders and tracked through corrective action. Write-back errors generated by a patient administration error (for example, incorrect or missing demographic information) is corrected by the MTF Patient Administration section. The medical coder may be used to correct all write-back errors caused by coding errors.
• Upon DHA or AFMS MCPO direction, utilizes MHS computer systems to remotely access patient records and assign codes for patient encounters in support of other MTFs included in this contract.
• May perform, with COR concurrence, limited focused audits of MTFs, specialties, clinics, or providers, not to exceed 10% of available time, IAW conducted IAW DHA requirements. If DHA requirements are not available at the time of award of this contract, all QA or peer reviews will be conducted IAW the latest version of the AFMS Coding Manual, or Service/NCR-MD instruction for any non-AF MTFs included in this contract.
• Coding validation notifications (a.k.a. “CAPER” validations) are reports of certain diagnosis codes which may need further investigation and provider clarification. These areas may include smallpox, anthrax, abortions, flu, hepatitis, TB and others as designated as a Congressional, DHA, or AFMS MCPO reporting requirement. The coder will review coding validation notifications from the AFMS MCPO and ensure that identified codes are correct, making corrections when necessary. Encounters should be corrected within 3 business days and providers receive training on the consequences of the use of the codes assigned.
• Provides or contributes to periodic reports IAW DHA and AFMS MCPO instructions and timelines.

• Formal Education: Candidates for this position are required to have ONE of the following to fulfill minimum educational requirements:
• An associate’s or higher degree in Health Information Management;
• A university certificate in medical coding;
• 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 an American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) coding certification preparation course for professional services or facility coding that includes medical terminology, anatomy and physiology, health information management concepts, and pharmacology. Education in section must be from an accredited educational institution recognized by the American Health Information Management Association (AHIMA) and/or American Academy of Professional Coders (AAPC).
• Required Coding Certifications: Candidates for this position are required to possess a current coding certification in good standing from EACH of the following categories:
• Professional Services Coding Certifications: The following are recognized professional certifications: Certified Professional Coder (CPC); or Certified Coding Specialist – Physician (CCS-P).
• Recommended Coding Certifications: It is recommended that candidates for this position are possess a current coding certification in good standing from EACH of the following categories:
• Institutional (Facility) Coding Certifications: Certified Outpatient Coder (COC); Certified Coding Specialist (CCS); National Alliance of Medial Auditing Specialists (NAMAS), and Certified E&M Auditor Credential (CEMA). Other institutional coding certifications will be considered by DHA or the AFMRA Medical Coding Office on a case-by-case basis. Note: A Registered Health Information Technician (RHIT); Registered Health Information Administrator (RHIA) from AHIMA will be considered for either a professional service coder certification or institutional coding certification on a case-by-case basis by DHA or AFMRA Medical Coding Office. Continuing Education Requirements: Medical coders shall maintain the required continuing education hours in order to maintain current and proper national certification(s) requirements for this position at no expense to the Government.
• Experience: MSS personnel in this position are required to possess a minimum of four (4) years of medical coding and/or auditing experience in two (2) or more medical, surgical and ancillary specialties within the past 10 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. 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.
• Coding Test. Pass a pre-employment coding test approved by the AFMRA/SGAR that includes questions and/or multiple choice scenarios on the following topics: Medical Terminology; Anatomy and Physiology; Outpatient, Emergency Department (ED), and Observation Evaluation and Management (E&M) coding and professional component of procedures; Ambulatory Surgery professional component of procedures; and Outpatient, ED, Observation, and Ambulatory Surgery facility component of procedures. Passing score for the coding is a minimum of 70%, with the candidate’s score to be reported in the qualification documents by the contractor management staff. If the candidate is an incumbent on a current contract, the test may be waived if the incumbent has demonstrated satisfactory performance and the MTF has no objections. The Contractor is required to document verification of satisfactory performance and MTF concurrence for inclusion in the incumbent candidate's qualification package.

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