ERP International is seeking a REMOTE Medcial Coding Auditor for a full-time position, supporting the Defense Health Agency. Apply online today and discover more about this outstanding practice opportunity. www.erpinternational.com
Be the Best! Join our team of exceptional health care professionals across the nation. Come discover the immense pride and job satisfaction ERP Employees experience in providing care for our Military Members, their Families and Retired Military Veterans! ERP International is honored to have been named one of The Washington Post’s 2022 Top Workplaces!
* Excellent Compensation & Exceptional Comprehensive Benefits! * Paid Time Off and Paid Federal Holidays!
* Medical/Dental/Vision, LTD/STD/Life, and Health Savings Account available, and more! * Annual CME Stipend and License/Certification Reimbursement!
* Matching 401K!
About ERP International, LLC: ERP is a nationally respected provider of health, science, and technology solutions supporting clients in the government and commercial sectors. We provide comprehensive enterprise information technology, strategic sourcing, and management solutions to DoD and federal civilian agencies in 40 states. Founded in 2006, ERP is headquartered in Laurel, MD and maintains satellite offices in Montgomery, AL and San Antonio, TX - plus project locations nationwide. ERP is an Equal Opportunity Employer - Disability and Veteran.
M-F, 7:30 to 4:30 PM
Knowledge and Skills
Candidates must possess the following knowledge:
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, 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.
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.
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).
Verify the accuracy of the diagnosis, procedure, supply codes, modifiers, and sequencing for the professional and institutional (facility) components of Inpatient, External Resource Sharing Agreement (ERSA), Ambulatory Procedure Visit (APV), Observation, Emergency Department (ED), and Outpatient encounters. Codes audited include International Classification of Diseases, Clinical Modification (ICD-CM), International Classification of Diseases, Procedural Classification System (PCS), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and modifiers. Assign errors IAW DHA-MCPB policies, procedures, rules, and standards, and provides clear, concise, official coding guidance, rationale, and reasons for assigning specific errors. Ensure strict confidentiality of medical records and audit findings. Complete assigned audits within timelines defined in the audit scope document and maintains an average of 97% coding accuracy and average of 90% auditing accuracy.
Provide second-level review of coding assignment to ensure compliance with legal and procedural policies to ensure optimal reimbursements while adhering to regulation prohibiting unbundling and other questionable practices. Review encounter and/or record documentation to identify inconsistencies or discrepancies that may cause inaccurate coding, medico-legal repercussions or impacts quality patient care. Identify any problems with legibility, abbreviations, etc., and brings to the provider’s attention. Examine records for proper sequence of documents, presence of authorized signatures, and sufficient data is documented that supports diagnosis, treatment administered, and results obtained.
Provide each assigned Market or MTF with coding audit accuracy data needed to complete their monthly Data Quality Review List/Statement and collaborate on the explanation and action plan to correct any measures not meeting performance standards IAW DHA-MCPB policies, procedures, rules, and standards. May also perform focused audits of DHA Markets, MTFs, specialties, clinics, or providers IAW DHA-MCPB guidelines, rules, and standards.
Research, analyze, and respond to inquiries, including focused audits, inappropriate coding, and adherence to Military Health System (MHS) coding guidelines.
May conduct or participate in reviews and evaluations of DHA-MCPB operations to determine progress, conformity to program requirements and identifies deficiencies and problems affecting cost and delivery of services. Recommend corrective action and methods to resolve problems and achieve compliance with policy. Provide general consultation and technical guidance in the establishment of new or redefined DHA-MCPB operating program guides, policies, and procedures. Plan and conduct projects to gather and analyze data which will improve organizational performance. Prepare reports associated with projects conducted. Prepare communication for widespread distribution within the organization. Develop reports related to productivity, operations, and utilization of resources to determine the effectiveness of programs and to resolve problems of significant consequences.
Assist the DHA-MCPB in developing an annual work plan of analysis, audit, and investigative items in collaboration with DHA/PAD. Stay abreast of changes in Federal laws, Department of Health and Human Services Office of Inspector General (HHS- OIG), DoD, DHA, and AFMS regulations, and commercial policies involving or affecting compliance. Collaborate with DHA leadership and clinical staffs in identifying and resolving compliance issues.
Assist the DHA-MCPB in monitoring coding compliance through performing audits of DHA coders in a double-blind audit method IAW DHA-MCPB guidelines, rules, and standards; and performing focused audits of DHA MTFs, specialties, clinics, or providers IAW DHA-MCPB guidelines, rules, and standards. This involves accurately analyzing diagnosis, procedure, and supply codes for the professional and institutional (facility) components of Inpatient, 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), International Classification of Diseases, Procedural Classification System (PCS), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and modifiers. The task also involves exercising independent and objective judgment in assigning errors, providing a rational and citing official guidelines, policies, regulations, rules, or standards as reference for assignment of errors.
Professionally interact with Market and/or MTF staff and other coders from different companies regarding coding and documentation rules, policies, procedures, and regulations. Obtain clarification of conflicting, ambiguous, or non-specific documentation. Provide advice, assistance, and technical support to Market and/or MTF staff, Medical Coders, reviewers, Medical Coding Compliance Specialists, and Medical Coding Trainers as appropriate regarding official coding guidance and regulatory provisions.
Make well-informed, effective, and timely decisions, even when data are limited, or solutions produce unpleasant consequences; perceives the impact and implications of decisions.
Receive, attend to, interpret, and respond to verbal messages and other cues such as body language in ways that are appropriate to listeners and situations.
Clearly express information (for example, ideas or facts) to individuals or groups effectively, taking into account the audience and nature of the information.
Utilize medical computer software programs to abstract, analyze, and/or evaluate clinical documentation and enter/edit diagnosis and procedure codes.
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.
Display courtesy, empathy, and tact, while developing and maintaining effective relationships with others; effectively work with individuals who are difficult, hostile, or distressed to resolve differences; and be able to relate well to people from varied backgrounds and in different situations.
Work with internal and external customers to assess their needs, provide information or assistance, resolve their problems, or satisfy their expectations.
Contribute to maintaining the integrity of the organization; display high standards of ethical conduct and understand the impact of violating these standards on an organization, self, and others.
Be open to change and new information; adapt behavior or work methods in response to new information, changing conditions, or unexpected obstacles; effectively deals with uncertainty.
A high level of effort and commitment towards performing the work, using efficient learning techniques to acquire and apply new knowledge and skills; use training, feedback, or other opportunities for self-learning and development.
Understand and interpret written material, including technical material, rules, regulations, instructions, reports, charts, graphs, or tables; apply what is learned from written material to specific situations.
Attention to detail and completeness with a thorough understanding of government rules and regulations, medical coding and reimbursement guidelines, and potential areas of risk for fraud.
Use imagination to develop new insights into situations and apply new solutions to problems; assist in designing new methods where established methods and procedures are not suitable or are unavailable.
A minimum of one of the following:
An Associates Degree in Health Information Management or Healthcare Administration or biological science.
A university, college, or technical school certificate in medical coding.
At least 30 semester hours relevant university/college credit of a grade of C, Pass, or better that includes relevant coursework suck as anatomy/physiology, medical terminology, health information management, and/or pharmacology.
Completion of An AAPC or AHIMA online or in person coding exam preparation course that includes medical terminology, anatomy, and physiology, health information management concepts, and pharmacology.
Completion of a training course beyond apprentice level for medical technicians hospital, corpsmen, medical service specialists, or hosptial training, obtained in a training program given by the Armed Forces or hte US Maritime Service under close medical and professional supervision.
License/Certification and Training: Must possess and maintain both Professional Services and Institutional (Facility) Coding Certifications.
Professional Services Coding Certifications: RHIT, RHIA, CPC, or CCS-P
Institutional (Facility) Coding Certifications: CIC, CCS, RHIT, or RHIA
Additional certificate needed: CPMA through AAPC, CEMA through NAMAS / other medical coding auditing certifications will be considered by the DHA- MCPB on a case by case basis.
Continuing Education Requirements: Auditors shall maintain the required continuing education to keep certifications current at all times
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.
Candidates must meet all of the following:
A minimum of eight (8) years of medical coding and/or auditing experience in four (4) or more medical, surgical, and ancillary specialties within the past 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.
Four (4) years of the eight (8) years of required coding experience must involve medical coding auditing functions. 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.
Must be able to obtain government clearance.