Job Description

Medical Coder

Dutch Ridge Consulting Group, LLC (DRCG) is an ISO 9001:2015, Small Business Administration (SBA) Certified Service-Disabled Veteran-Owned Small Business (SDVOSB). DRCG provides cleared technical support staff throughout the United States with corporate offices in Ashburn, Virginia. DRCG offers expertise in Systems Integration (SI), Information Technology (IT) solutioning, Program Management, Risk Management, Business Process Reengineering (BPR), Requirements Engineering, Workflow Solutioning, and Business Consulting Services. Established in 2016, DRCG is 100% US owned and predominately supports the DoJ, DoW, and DHS. DRCG optimizes client investments by leveraging expertise to better manage the growth and transformation of existing IT environments.

DRCG is seeking a highly motivated, Medical Coder, to support a federal client. The Medical Coder is responsible for performing remote coding and will use skills, training, and knowledge of International Classification of Diseases, Current Procedural Terminology, and Healthcare Common Procedure Coding System Level II code sets and guidelines and other generally accepted available resources to review health record documentation and providers' scope of practice to assign diagnostic and procedural codes.

The Medical Coder will code Outpatient Encounters including Radiology, Lab, or other Ancillary Services, and include the required encoder/HER data elements in accordance with Veterans Health Administration (VHA) Handbooks. Other identified cases to be coded include, but not limited to, Veteran Tortfeasor Claims, Veteran Workers' Compensation, Humanitarians, beneficiaries of the Military Health System (TRICARE), Civilian Health and Medical Program of the Department of Veterans Affairs, Ineligibles, Fugitive Felon, Prosthetics, non-Veterans Affairs Fee Services, and New Insurance/Late Checkout. Perform remote coding on all inpatient/outpatient visits and surgical procedures by VA Health Care System (VAHCS). They access VA's VistA/CPRS system to read and code medical records identified by VA and enter codes into the approved encoder or other package. The Medical Coder is required to comply with all HIPAA provisions for a Business Associate, and all provisions in this Performance Work Statement.

Location: Remote

Clearance Required: Active Tier 1 / Public Trust (Federal Suitability Determination)

Must have recent experience (within the last 5-years) supporting the Department of Veterans Affairs.

Required Skills and Abilities:

• Responsible for being qualified and competent to perform coding services and activities (there shall be no reimbursement charge for mileage, travel times, meals, parking, etc)
• Must maintain a minimum of 95% accuracy rate on all auditing scores
• Must complete coding activities within five (5) calendar days from assignment
• Possess formal training in anatomy and physiology, medical terminology, pathology and disease processed, pharmacology, health record format and content, reimbursement methodologies and conventions, rules and guidelines for current classification systems (ICD, CPT, HCPCS, E&M, etc.)
• Experience with the Evaluation and Management (E/M) guidelines applicable to the date of service
• Experience and proficiency in 1995 and 1997 E/M documentation guidelines for legacy and retrospective encounters and 2021 and 2023 E/M guidelines for current encounters
• Experience with ensuring coding accuracy and compliance with VA, CPT, and CMS aligned standards, particularly for retrospective coding and accounts referred by billing
• Experience abstracting other identified data items and enter the data into the local EHR encoder program
• Utilize the standardized reasons in the encoder application to communicate specific document information to Billing
• Utilize the national encoder product and EHR, if necessary, to reflect code changes and name(s) of provider(s)
• Reading and reviewing documentation in the electronic health record
• Complete data entry into the encoder
• Provide input to weekly, monthly, and quarterly reports
• Comply with all VA privacy and security requirements
• Apply –GR, G8, QK, QX, QS, QY, and G9 modifiers correctly.
• Apply knowledge of current Diagnostic Coding and Reporting Guidelines for outpatient services.
• Apply knowledge of CPT format, guidelines, and notes to locate the correct codes for all services and procedures performed during the encounter/visit and sequence them correctly
• Apply knowledge of procedural terminology to recognize when an unlisted procedure code must be used in CPT.
• Code in accordance with Correct Coding Initiative (CCI) Bundling Guidelines.
• Use the CMS Common Procedural Coding Systems (HCPCS), where appropriate.
• Be able to code inpatient discharges when requested by VHA; e.g., quarterly census, etc.
• Must complete the yearly privacy and security processes and training as required by the VAHCS.

Education and Experience:

• Minimum of Two (2) years' experience in outpatient coding
• Must be credentialed and have completed an accredited program for coding certification, an accredited health information management or health information technician. A certified coder is someone credentialed by the: American Health Information Management Association (AHIMA) and includes RHIA, RHIT, CCS and CCS-P, or
• American Academy of Professional Coders (AAPC) as a CPC or CPC-H
• Knowledge and familiarity with the VHA national encoder, industry standard guidelines, VHA and local policies, and other generally accepted reference materials to assign and/or validate diagnostic and procedure codes reflective of documentation

Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer

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