The Auditor will be responsible for the coding of Inpatient or Outpatient, Inpatient or Outpatient Professional Services, Emergency Room, APVs and Outpatient medical services provided to Government beneficiaries.
Daily activities would include resolving any coding discrepancies, mediating disputes, setting audit assignments, time and attendance, and performance improvement planning.
Provide educational feedback to the Government, Auditors and Provider’s addressing inappropriate patterns of documentation of records audited. Maintain records and statistics to include quality control measures, CCE reporting, accuracy of coding, workload completed and ad hoc reports as required.
The Contractor shall develop and execute training that is specific to the clinical services provided by the MTF and will incorporate standardized training guidance to facilitate evolving requirements (i.e. ICD-10 implementation).
Management Support Workload Data:
1. Prepares approximately 52 productivity summaries per year.
2. Ensures accurate coding of medical records utilizing IAW, JC, and MTF guidelines.
3. Participate in all mandatory Command training.
Required Skills and Experience:
The Lead Auditor shall have sufficient experience in the medical coding area with a minimum of three (3) years of continuous medical records coding, auditing and supervisory experience required and the following specific skills:
1. Certified Professional Coder (Need to be certified through one of the following organizations: American Academy Professional Coders (AAPC) credentials – CPC, CPC-H, CPC-P, CPMA or American Health Information Management Associations (AHIMA) credentials – RHIA, RHIT, CCS, and CCS-P)
2. Extensive knowledge for understanding and applying the official coding clinic guidelines
3. Knowledge of medical terminology and usage, including general medical, surgical, pharmaceutical, hospital terms and abbreviations and abstracting techniques
4. Knowledge of a broad range of references such as the ICD-10, ICD9CM, CPT, CS, medical dictionaries, manuals relating to coding textbooks and glossaries
5. Knowledge of legal and regulatory requirements of medical records
6. Knowledge of medical records procedures, regulations and principles to carry out a variety of medical records functions such as analysis, coding, ensuring compliance, and compiling data
7. Knowledge of data collection methods for basic health care, research information and statistical reporting
8. Knowledge of laws and regulations on the confidentiality of medical records
9. Skill in effective oral and written communication
Background check will be done. Must be able to obtain security clearance. Candidates with Active Secret Clearance highly desirable.