Medical Coding Compliance Specialist - Onsite Only - Jacksonville FL - Relocation assistance available for US citizens

Summary:

• 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.

Knowledge and Skill:

• 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).
• 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.
• 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.
• Ability to write reports, business correspondence, and procedure manuals.
• Organizational, analytical, time management, statistical, and problem solving skills.
• Advanced knowledge of computers, keyboard skills, and various software programs including

Education/Certification:

• A minimum of one of the following: An associate degree in health information management OR a  certificate in medical coding, OR at least 30 hours university/college credit that includes relevant  coursework such as anatomy/physiology, medical terminology, health information management, and/or pharmacology
• RHIT, RHIA, CPMA, CPC CCS, or CCS-P
• Must maintain the required CEU's and credentials
• Must successfully complete ICD-10-CM proficiency test 120 days from start date

Experience:

• 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.
• 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.
• 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.

Performance Outcomes:

• Responsible for assignment of accurate ICD and HCPCS codes, modifiers, and quantities from medical record documentation for institutional/facility coding, leading to accurate assignment of MS-DRGs.
• Responsible for assignment of accurate Evaluation and Management (E&M), ICD, CPT, and HCPCS codes and modifiers for professional services encounters, based on the medical record documentation.
• Meets productivity and accuracy standards in accordance with AFMS policy and regulation.
• Assists in development and execution of focused audit plans.
• Identifies and abstracts information from medical records (paper or electronic) for special studies and audits, internal and external, analyzing and identifying coding and and/or documentation.
• Develops training plans from remedial/refresher, to just-in-time corrective and new training materials to continuously improve coding accuracy and documentation.
• Delivers training presentations for general coding, ICD-10, and coding compliance provider training as assigned by the Government.
• Effectively analyze provider diagnosis and procedure documentation and identify clinical documentation improvement (CDI) opportunities, producing appropriate CDI queries and educating providers on the value of improved documentation, recommending ways to improve clinical documentation skills.
• Assists the AFMOA Coding Program Office in identifying compliance issues and analyzing practice patterns and recommending changes to policies and procedures; recommending/updating standard policies and procedures; contributing to risk assessments and mitigation strategies; and assisting with data collection and statistical report generation.