May 24, 2024

DHA Medical Coding Compliance Specialist - (Hybrid Remote)

  • Serco North America
  • Washington, DC, United States

Job Description

Position Description :

Serco is excited to continue our support to the Defense Heath Agency (DHA) Medical Coding Program Branch. The DHA is a joint, integrated Combat Support Agency that enables the Army, Navy, and Air Force medical services to provide a medically ready force to Combatant Commands in both peacetime and wartime. The essential mission of the DHA Medical Coding Program Branch (DHA-MCPB) is to improve the accuracy and quality of medical coding and documentation across DHA in support of the DHA mission.

This is a 100% Remote position.

Our Medical Coding Compliance Specialists seek to prevent activity or actions in medical coding and documentation that could lead to fraud, waste, or abuse. It involves performing analysis, auditing, investigation, research, reporting, and other tasks to support development, implementation, operation, and oversight of DHA medical coding compliance.

In this role, you will:

  • The work will encompass all 400 Military Treatment Facilities and Dental clinics assigned to DHA Markets.
  • The work may include multiple conference calls, virtual meetings, and onsite visits to DHA organizational elements inside the continental United States (CONUS) and outside of the continental United States (OCONUS).
  • Specifically, the work of the Medical Coding Compliance Specialists involves significant use of computers; review of Federal laws, regulations, guidance, publications, and standards; industry guidelines, publications, and standards; development of position papers, reports, and analyses; perform investigations and provide findings on reports of non-compliance with DHA coding and documentation guidance, instructions, policies, procedures, and standards; development and performance of revenue integrity projects; and analysis, evaluation, review, and recommendations for changes and updates to the CDM and other systems and processes impacting medical coding.


Qualifications:

To be successful in this role, you will have:

  • An associate degree or higher in Health Information Management or Healthcare Administration or biological science. (All candidates for this position will be required to provide documentation of education (e.g., copies of diplomas, certificates, transcripts, or other documentation) in the candidates qualification package.)
    • Or a university, college, or technical school certificate in medical coding
    • Or at least 30 semester hours university/college credit of a grade of C, Pass, or better, that includes relevant coursework such as anatomy/physiology, medical terminology, health information management, and/or pharmacology
    • Or successful completion of an American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) online or in-person coding exam preparation course that includes medical terminology, anatomy and physiology, health information management concepts, and pharmacology
    • Or successful completion of a training course beyond apprentice level for medical technicians, hospital corpsmen, medical service specialists, or hospital training, obtained in a training program given by the Armed Forces or the U.S. Maritime Service under close medical and professional supervision.
  • Pre-employment Coding Compliance Specialist Test- Prospective candidates must pass a pre-employment Medical Coding Compliance Specialist Test, with a score of 70% or better.
    • If the candidate is an incumbent on a current or prior DHA or Military Department (MILDEP) contract, the test may be waived IF the incumbent has demonstrated satisfactory performance and otherwise meets the qualifications for the position.
  • Posses a NACI clearance
  • Up to 10% travel
  • You are required to possess a coding certification in good standing in each of the following categories: (NOTE: The AHIMA RHIT or RHIA credential may be counted towards either the professional services or institutional coding certification requirement, but not both unless the individual possesses the required institutional AND professional services experience for the specific position sought.) Developmental Classification: A Medical Coding Compliance Specialist candidate that do not meet all required certifications may be accepted in a developmental classification at 90% of the Full Performance salary. Employees assigned to a Developmental Classification will be required to signs a memorandum of agreement (MOA) with Serco agreeing to eliminate the deficiency within an agreed to timeframe.)
    • Professional Services Coding Certifications: ONE of the following recognized professional coding certifications: Registered Health Information Technician (RHIT); Registered Health Information Administrator (RHIA); Certified Professional Coder (CPC); or Certified Coding Specialist Physician (CCS-P). Other professional coding certifications will be considered by the DHA-MCPB on a case-by-case basis.
    • Institutional (Facility) Coding Certifications: ONE of the following recognized institutional coding certifications: Registered Health Information Technician (RHIT); Registered Health Information Administrator (RHIA); Certified Inpatient Coder (CIC), or Certified Coding Specialist (CCS). Other institutional coding certifications will be considered by the DHA-MCPB on a case-by-case basis.
    • Coding Compliance Certifications: ONE of the following recognized coding compliance certifications:
      • 1) AAPC: Certified Professional Compliance Officer (CPCO)
      • 2) Health Care Compliance Association (HCCA): Certified in Healthcare Compliance (CHC)
    • Evaluation and Management Auditing Certification:
      • National Alliance of Medical Auditing Specialists (NAMAS) Certified Evaluation and Management Auditor (CEMA).
    • Continuing Education Requirements:
      • Medical coding personnel 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.
  • A minimum of ten years of medical coding and/or auditing experience in two or more medical, surgical, and ancillary specialties within the past 15 years, including at least five (5) years of experience in an auditing, training, or compliance role
    • OR a minimum of three (3) years of auditing, training, and/or compliance experience within the last six (6) years in a military coding environment.
  • When claiming medical coding experience, 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 limited to making codes conform to specific payer requirements for the business office (insurance billing, accounts receivable) is not a qualifying factor.
  • When claiming training experience, training expertise must include identifying coding training opportunities, developing training plans and material, and instruction/delivery of the training to medical coder and clinical audiences.
  • Coding, auditing, and training exclusively for specialties such as home health, skilled nursing facilities, and rehabilitation care will not be considered as qualifying auditing experience.
  • When claiming compliance experience, 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.
  • 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 of anatomy, physiology, disease processes, medical and surgical procedures, and medical terminology, including accepted medical abbreviations to perform the full scope of inpatient coding, including inpatient discharges, surgical cases, diagnostic studies and procedures, and inpatient professional services and facility encounters.
  • Advanced knowledge of medical coding processes, procedures, regulations, guidelines, and principles to complete routine and non-routine medical record examination and coding tasks.
  • Skill in examining and extracting written and numerical data from medical documentation, to draw conclusions and generate reports based on factual documentary evidence to apply appropriate codes and identify documentation inconsistencies.
  • Ability to utilize medical computer software programs to abstract, analyze, and/or evaluate clinical documentation and enter/edit diagnosis and procedure codes.
  • Advanced knowledge of Compliance program requirements and/or initiatives (ex. HIPAA violations and fraud, documentation guidelines, and billing guidelines).
  • 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. 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.
  • Write in a clear, concise, organized, and convincing manner for the intended audience; use correct English grammar, punctuation, and spelling; communicate information (for example, facts, ideas, or messages) in a succinct and organized manner; produce written information, which may include technical material, that is appropriate for the intended audience.
  • Intermediate ability to assist with development of online training courses.
  • Advanced knowledge of revenue cycle management, training methods, clinical documentation improvement, and continuous process improvement processes.
  • Practical knowledge of project management concepts, business analysis, and CDM concepts and guidance, to include the National Uniform Billing Committee (NUBC) Official UB-04 Data Specifications Manual.

Additional desired experience and skills:

  • Military Health System (MHS) and/or Defense Health Agency (DHA) work experience.
  • Auditing Certifications: AAPC: Certified Professional Medical Coding Auditor (CPMA). Other medical coding auditing certifications will be considered by the DHA-MCPB on a case-by-case basis.
  • Healthcare Revenue Integrity Certification: Certification in Healthcare Revenue Integrity (CHRI) from National Association of Healthcare Revenue Integrity (NAHRI). Other healthcare revenue integrity certifications will be considered by the DHA-MCPB on a case-by-case basis.

In compliance with state and local laws regarding pay transparency, the salary range for this role is $62,704.34 to $101,895.84 however, Serco considers several factors when extending an offer, including but not limited to, the role and associated responsibilities, a candidate's work experience, education/training, and key skills.



Company Overview :

Serco Inc. (Serco) is the Americas division of Serco Group, plc. In North America, Sercos 9,000+ employees strive to make an impact every day across 100+ sites in the areas of Defense, Citizen Services, and Transportation. We help our clients deliver vital services more efficiently while increasing the satisfaction of their end customers. Serco serves every branch of the U.S. military, numerous U.S. Federal civilian agencies, the Intelligence Community, the Canadian government, state, provincial and local governments, and commercial clients. While your place may look a little different depending on your role, we know you will find yours here. Wherever you work and whatever you do, we invite you to discover your place in our world. Serco is a place you can count on and where you can make an impact because every contribution matters.

To review Serco benefits please visit: https://www.serco.com/na/careers/benefits-of-choosing-serco. If you require an accommodation with the application process please email: careers@serco-na.com or call the HR Service Desk at 800-628-6458, option 1. Please note, due to EEOC/OFCCP compliance, Serco is unable to accept resumes by email.

Candidates may be asked to present proof of identify during the selection process. If requested, this will require presentation of a government-issued I.D. (with photo) with name and address that match the information entered on the application. Serco will not take possession of or retain/store the information provided as proof of identity. For more information on how Serco uses your information, please see our Applicant Privacy Policy and Notice.

Serco does not accept unsolicited resumes through or from search firms or staffing agencies without being a contracted approved vendor. All unsolicited resumes will be considered the property of Serco and will not be obligated to pay a placement or contract fee. If you are interested in becoming an approved vendor at Serco, please email Agencies@serco-na.com.

Serco is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.