Medical Records Technician (Coder) Auditor (Inpatient)
Auditors must be able to perform all duties of a MRT (Coder). Auditors serve as experts of current coding conventions and guidelines related to professional and facility coding. Auditors perform audits of encounters to identify areas of non-compliance in coding. They facilitate improved overall quality, completeness, and accuracy of coded data. Specific Functions:
Reviews, analyzes and reports performance monitors for PTF, PCE, VERA and Non-VA Medical Care (purchased care) coding. Audit accurate and complete assignment of ICD-10-CM and ICD-10-PCS codes, MS-DRG, POA status, and discharge disposition values for inpatient health records. Audit function includes evaluation of clinical documentation to support optimal code assignment. Reviews coding and assist coders in improving coding accuracy; provides coding guidance to various levels of staff to promote consistency in practice and compliance with coding rules and regulations; initiates various reports and analyze data. Facilitates improved overall quality, completeness and accuracy of coded data. Ensures the accuracy and completeness of clinical information used for measuring and reporting physician and medical center outcomes with continuing education to all members of the patient care team on an ongoing basis. Responsible for performing audits of coded data, developing criteria, collecting data, graphing and analyzing results, creating reports and communicating in writing and/or in person to appropriate leadership and groups. Collaboratively works with coding staff and clinical staff to provide support and education on coding issues. Provides training and education to coding and clinical staff. Researches complex coding issues and participates in process improvements related to coding. Assists in the development of guidelines for data quality, consistency, and monitoring for compliance to improve the quality for clinical, financial, and administrative data to ensure that all coded data is fully documented and supported. Such efforts are conducted to ensure the accuracy of billing denials and prevention against fraud and abuse and to optimize the medical center's authorized reimbursement for utilization of resources provided. As a technical expert in health information coding matters, provides advice and guidance on documentation and coding requirements. Maintains current knowledge to ensure that coding and documentation meets regulatory guidelines and audit standards, and results in appropriate data capture and reimbursement. Analyze audit results and prepare summary feedback for individual coders and/or clinicians, making recommendations for improvement. Provide coding consultation to coders and/or clinicians related to coding and documentation questions. Maintains statistical database(s) to track the results and validate the program for identifying patterns and variations in coding practices with regular reports to the medical staff and management. Work Schedule:
Monday - Friday, 8:
00am - 4:
30pm Virtual:
Yes Financial Disclosure Report:
Not required Basic Requirements:
Citizenship:
Citizen of the United States English Language Proficiency
Experience:
At least one (1) year of creditable experience that indicates knowledge of medical terminology, anatomy, physiology, pathophysiology, medical coding, and the structure and format of health records OR Education:
An associate degree from an accredited college or university recognized by the U.S. Department of Education with a major field of study in health information technology/health information management, or a related degree with a minimum of 12 semester hours in health information technology/health information management (e.g., courses in medical terminology, anatomy and physiology, medical coding and introduction to health records). OR Completion of an AHIMA approved Coding Program:
Completed of an AHIMA approved coding program or other intense coding training program of approximately one year or more that included courses in anatomy and physiology, medical terminology, basic ICD diagnostic/procedural, and basic CPT coding. The training program must have led to eligibility for coding certification/certification examination and the sponsoring academic institution must have been accredited by a national U.S. Department of Education accreditor, or comparable international accrediting authority at the time the program was completed. OR Experience/Education Combination:
Equivalent combinations of creditable experience and education are qualifying for meeting the basic requirements. The following education/training substitutions are appropriate for combining education and creditable
Experience:
Six months of creditable experience that indicates knowledge of medical terminology, general understanding of medical coding and the health record, and one year above high school with a minimum of 6 semester hours of health information technology courses. Successful completion of a course of medical technicians, hospital corpsmen, medical service specialists, or hospital training obtained in a training program given by the Armed Forces or the U.S. Maritime Service under close medical and professional supervision may be substituted on a month-for-month basis for up to six months of experience provided the training program included courses in anatomy, physiology, and health record techniques and procedures. Also, requires six additional months of creditable experience that is paid or non-paid employment equivalent to MRT Coder. Certification Requirement:
Mastery Level Certification through AHIMA or AAPC. (Required for this position) Master Level Certification:
Certification is limited to those obtained through AHIMA or AAPC. To be acceptable for qualifications, the specific certification must represent a comprehensive competency in the occupation. Stand-alone specialty certifications do not meet the definition of mastery level certification and are not acceptable for qualifications. Certification titles may change and certifications that meet the definition of mastery level certification may be added/removed by the above certifying bodies. However, current mastery level certifications include:
Certified Coding Specialist (CCS), Certified Coding Specialist - Physician-based (CCS-P), Registered Health Information Technician (RHIT), Registered Health Informatic Administrator (RHIA), Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Inpatient Coder (CIC). NOTE:
Copy of Certifications will be required at time of application. May qualify based on being covered by the Grandfathering Provision as described in the VA Qualification Standard for this occupation (only applicable to current VHA employees who are in this occupation and meet the criteria). Preferred
Experience:
A minimum of 3 years inpatient coding experience and a minimum of 1-year auditing experience. Grade Determinations:
Medical Records Technician (Coder) Auditor, GS-9. In addition to the basic requirements above, applicants must have at least one full year of creditable experience equivalent to the journey grade level of a MRT (Coder) (GS-8). Auditors must be able to perform all duties of a MRT (Coder). In addition to the experience above, applicants must demonstrate the following KSAs:
(1) Advanced knowledge of current coding classification systems such as ICD, CPT, and HCPCS for the subspecialty being assigned (outpatient and inpatient) (2) Ability to research and solve complex questions related to coding conventions and guidelines in an accurate and timely manner (3) Ability to review coded data and supporting documentation to identify adherence to applicable standards, coding conventions and guidelines, and documentation requirements. (4) Ability to format and present audit results, identify trends, and provide guidance to improve accuracy (5) Skill in interpersonal relations and conflict resolution to deal with individuals at all organizational levels. Creditable
Experience:
Experience is only creditable if it is directly related to the position to be filled. To be creditable, the candidate's experience must have demonstrated the use of knowledge, skills, and abilities) KSAs) associated with current practice and must be paid or non-paid employment equivalent to an MRT (Coder). References:
VA Handbook 5005/122, Part II, Appendix G57 The full performance level of this vacancy is GS-09 Physical Requirements:
The work is sedentary, but may require walking, bending, standing, and /or carrying of light items such as files and manuals.
Estimated Salary: $20 to $28 per hour based on qualifications.
Reviews, analyzes and reports performance monitors for PTF, PCE, VERA and Non-VA Medical Care (purchased care) coding. Audit accurate and complete assignment of ICD-10-CM and ICD-10-PCS codes, MS-DRG, POA status, and discharge disposition values for inpatient health records. Audit function includes evaluation of clinical documentation to support optimal code assignment. Reviews coding and assist coders in improving coding accuracy; provides coding guidance to various levels of staff to promote consistency in practice and compliance with coding rules and regulations; initiates various reports and analyze data. Facilitates improved overall quality, completeness and accuracy of coded data. Ensures the accuracy and completeness of clinical information used for measuring and reporting physician and medical center outcomes with continuing education to all members of the patient care team on an ongoing basis. Responsible for performing audits of coded data, developing criteria, collecting data, graphing and analyzing results, creating reports and communicating in writing and/or in person to appropriate leadership and groups. Collaboratively works with coding staff and clinical staff to provide support and education on coding issues. Provides training and education to coding and clinical staff. Researches complex coding issues and participates in process improvements related to coding. Assists in the development of guidelines for data quality, consistency, and monitoring for compliance to improve the quality for clinical, financial, and administrative data to ensure that all coded data is fully documented and supported. Such efforts are conducted to ensure the accuracy of billing denials and prevention against fraud and abuse and to optimize the medical center's authorized reimbursement for utilization of resources provided. As a technical expert in health information coding matters, provides advice and guidance on documentation and coding requirements. Maintains current knowledge to ensure that coding and documentation meets regulatory guidelines and audit standards, and results in appropriate data capture and reimbursement. Analyze audit results and prepare summary feedback for individual coders and/or clinicians, making recommendations for improvement. Provide coding consultation to coders and/or clinicians related to coding and documentation questions. Maintains statistical database(s) to track the results and validate the program for identifying patterns and variations in coding practices with regular reports to the medical staff and management. Work Schedule:
Monday - Friday, 8:
00am - 4:
30pm Virtual:
Yes Financial Disclosure Report:
Not required Basic Requirements:
Citizenship:
Citizen of the United States English Language Proficiency
Experience:
At least one (1) year of creditable experience that indicates knowledge of medical terminology, anatomy, physiology, pathophysiology, medical coding, and the structure and format of health records OR Education:
An associate degree from an accredited college or university recognized by the U.S. Department of Education with a major field of study in health information technology/health information management, or a related degree with a minimum of 12 semester hours in health information technology/health information management (e.g., courses in medical terminology, anatomy and physiology, medical coding and introduction to health records). OR Completion of an AHIMA approved Coding Program:
Completed of an AHIMA approved coding program or other intense coding training program of approximately one year or more that included courses in anatomy and physiology, medical terminology, basic ICD diagnostic/procedural, and basic CPT coding. The training program must have led to eligibility for coding certification/certification examination and the sponsoring academic institution must have been accredited by a national U.S. Department of Education accreditor, or comparable international accrediting authority at the time the program was completed. OR Experience/Education Combination:
Equivalent combinations of creditable experience and education are qualifying for meeting the basic requirements. The following education/training substitutions are appropriate for combining education and creditable
Experience:
Six months of creditable experience that indicates knowledge of medical terminology, general understanding of medical coding and the health record, and one year above high school with a minimum of 6 semester hours of health information technology courses. Successful completion of a course of medical technicians, hospital corpsmen, medical service specialists, or hospital training obtained in a training program given by the Armed Forces or the U.S. Maritime Service under close medical and professional supervision may be substituted on a month-for-month basis for up to six months of experience provided the training program included courses in anatomy, physiology, and health record techniques and procedures. Also, requires six additional months of creditable experience that is paid or non-paid employment equivalent to MRT Coder. Certification Requirement:
Mastery Level Certification through AHIMA or AAPC. (Required for this position) Master Level Certification:
Certification is limited to those obtained through AHIMA or AAPC. To be acceptable for qualifications, the specific certification must represent a comprehensive competency in the occupation. Stand-alone specialty certifications do not meet the definition of mastery level certification and are not acceptable for qualifications. Certification titles may change and certifications that meet the definition of mastery level certification may be added/removed by the above certifying bodies. However, current mastery level certifications include:
Certified Coding Specialist (CCS), Certified Coding Specialist - Physician-based (CCS-P), Registered Health Information Technician (RHIT), Registered Health Informatic Administrator (RHIA), Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Inpatient Coder (CIC). NOTE:
Copy of Certifications will be required at time of application. May qualify based on being covered by the Grandfathering Provision as described in the VA Qualification Standard for this occupation (only applicable to current VHA employees who are in this occupation and meet the criteria). Preferred
Experience:
A minimum of 3 years inpatient coding experience and a minimum of 1-year auditing experience. Grade Determinations:
Medical Records Technician (Coder) Auditor, GS-9. In addition to the basic requirements above, applicants must have at least one full year of creditable experience equivalent to the journey grade level of a MRT (Coder) (GS-8). Auditors must be able to perform all duties of a MRT (Coder). In addition to the experience above, applicants must demonstrate the following KSAs:
(1) Advanced knowledge of current coding classification systems such as ICD, CPT, and HCPCS for the subspecialty being assigned (outpatient and inpatient) (2) Ability to research and solve complex questions related to coding conventions and guidelines in an accurate and timely manner (3) Ability to review coded data and supporting documentation to identify adherence to applicable standards, coding conventions and guidelines, and documentation requirements. (4) Ability to format and present audit results, identify trends, and provide guidance to improve accuracy (5) Skill in interpersonal relations and conflict resolution to deal with individuals at all organizational levels. Creditable
Experience:
Experience is only creditable if it is directly related to the position to be filled. To be creditable, the candidate's experience must have demonstrated the use of knowledge, skills, and abilities) KSAs) associated with current practice and must be paid or non-paid employment equivalent to an MRT (Coder). References:
VA Handbook 5005/122, Part II, Appendix G57 The full performance level of this vacancy is GS-09 Physical Requirements:
The work is sedentary, but may require walking, bending, standing, and /or carrying of light items such as files and manuals.
- Department:
0675 Medical Records Technician - Salary Range:
$64,535 to $83,897 per year
Estimated Salary: $20 to $28 per hour based on qualifications.
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