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Medical Coding Auditor

4 months ago

Fort Belvoir, United States Seneca Holdings LLC Full time

Great Hill Solutions is currently seeking a Medical Coding Auditor in support of a Defense Health client in the DC Metropolitan Area. The objective is to audit the NCR-MD's medical encounters to ensure optimal medical records coding program performance and improve coding accuracy, enhance quality documentation, and maximize reimbursements.

Responsibilities include, but are not limited to:

  • Remotely audit NCR medical encounters via VPN and/or on-site while supporting the Data Quality Review List/Statement, ensuring accurate coding, trend analysis, and providing timely advice, assistance and feedback.
  • Audit medical documentation and codes for compliance with federal coding regulations and guidelines. This shall include the assignment of International Classification of Diseases (ICD), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), Present on Admission (POA), Medical Severity-Diagnosis Related Groups (MS-DRG) codes, modifiers, and quantities as documented by the physician or adjusted by the coder.
  • Verify relevant information including the accuracy of the diagnosis, current procedural terminology, medical severity diagnosis related group, sequencing, etc., and prepare reports on the findings.
  • Develop a robust error tracking, trend analysis and monthly technical reporting process at the provider, clinic, MTF, and NCR-MD's levels.
  • Use monthly reports to develop training presentations to improve coding across all supported areas.
  • Provide each MTF with data needed to complete their monthly Data Quality Review List/Statement and collaborate on explanations and action plans to correct any measures not meeting performance standards.
  • Perform a minimum of 30 inpatient audits for facilities with inpatient encounters, 30 APV for facilities with APV encounters, and 30 outpatient audits for each DQ measured facility per month.
  • Review coding assignments to ensure compliance with legal and procedural policies and meeting optimal reimbursements while adhering to regulation prohibiting unbundling and other questionable practices.
  • Research, analyze, and respond to inquiries, including focused audits, regarding compliance, inappropriate coding, denials, billable services, and adherence to MHS coding guidelines.
  • Professionally interact with facility staff and other contract coders from different companies regarding coding rules, documentation policies, procedures, and regulations.
  • Obtain clarification of conflicting, ambiguous, or non-specific documentation and provide official supporting documentation regarding errors and audit results.
  • Train, instruct, and provide advice, assistance, and technical support to staff and medical coders, reviewers, and trainers as appropriate.
  • Ensure confidentiality and Proper Handling of PHI/PII when working with medical records and audit findings.
Basic Qualifications and Skills:
  • Active Public Trust clearance
  • Computer literate, with knowledge of coding and auditing packages, mainframes and office software applications.
  • Ability to adapt and modify medical billing procedures, protocol, and data management systems to meet specific operating requirements.
  • Ability to clearly communicate medical information to professional practitioners and/or to the general public.
  • Strong communication and interpersonal skills.
  • Ability to use independent judgment and to manage and impart confidential information.
  • Ability to analyze and solve problems.
  • Ability to provide guidance and training to professional and technical staff in area of expertise.
  • Ability to communicate effectively, both orally and in writing.
  • Ability to produce reports, business correspondence, and briefs.
  • Must possess ability to pass security clearance or have a current National Agency Check with Local Agency Check and Credit Check (NACLC).
  • The work is primarily sedentary. Requirements may include prolonged walking, standing, sitting or bending. Carrying or lifting of medical records may be required daily. Use of one or more computer programs and monitors may be required daily.
  • Ability to work independently as well as collaboratively.
  • The Contractor is required to be on-site.
  • Must be a U.S. Citizen.
Required Education:
  • Possess one or more of following recognized certifications: Registered Health Information Technologist (RHIT) or Registered Health Information Administrator (RHIA), Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Coder Specialist (CCS), Certified Coder Specialist - Physician (CCS-P), Certified Professional Coder-Hospital (CPC-H).
    • Current certification must be granted by an accrediting institution recognized by the American Health Information Management Association (AHIMA) and/or American Academy of Professional Coders (AAPC).
Required Experience:
  • A minimum of 5 years medical coding experience encompassing multiple clinical specialties and 3 years of medical auditing experience within the last eight years is required.
  • Candidates possessing a Certified Professional Medical Auditor (CPMA) certification must have a minimum of 2 years medical auditing experience with the last 5 years of medical coding experience encompassing multiple clinical specialties.
  • Candidate shall have recent experience within the last 2 years with unique military healthcare systems (to perform the requirements of this contract at the start and throughout the length of the contract) including but not limited to Armed Forces Health Longitudinal Technology Application (AHLTA), Composite Health Care System (CHCS), etc.
  • Candidate shall be familiar with the content of military electronic and paper records, layout, sections, family member prefix designation, forms used in a MTF, the medical records tracking procedures, EssentrisTM, the client-server version of the Clinical Information System (CIS), Coding Compliance Editor (CCE), NCR-MD's Internal Coding Auditing Methodology, NCR-MD Audit Tool, Coding Data Analysis System (CDAS), and MHS Coding Guidelines.
  • Detailed knowledge of anatomy, physiology and disease process, medical terminology, coding guidelines (inpatient, outpatient, and ambulatory surgery), documentation requirements, familiarity with medications, and reimbursement guidelines and experience with encoder.
  • Detailed knowledge of auditing concepts and principles, DoD, UBU, NCR-MD, Joint Commission, and AAAHC requirements.
  • Detailed knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation.
  • Advanced knowledge of medical coding and billing systems, procedures, documentation requirements, and regulatory requirements.
  • Detailed knowledge of current and developing issues and trends within medical coding procedure requirements.


Diversity, Equity & Inclusion Statement:

The Seneca Holdings family of companies is committed to building an inclusive work environment that encourages, supports, and celebrates the diversity of our employees. We recognize that an inclusive corporate culture improves how we support our customers and also improves the collective impact we can make in our communities.

Equal Opportunity Statement:

Seneca Holdings provides equal employment opportunities to all employees and applicants without regard to race, color, religion, sex/gender, sexual orientation, national origin, age, disability, marital status, genetic information and/or predisposing genetic characteristics, victim of domestic violence status, veteran status, or other protected class status. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, recall, transfer, leave of absence, compensation and training. The Company also prohibits retaliation against any employee who exercises his or her rights under applicable anti-discrimination laws. Notwithstanding the foregoing, the Company does give hiring preference to Seneca or Native individuals. Veterans with expertise in these areas are highly encouraged to apply.