Auditing Specialist - Washington, United States - Serco North America

Serco North America

Verified Company

Washington, United States

3 weeks ago

Posted by:

Mark Lane

beBee recruiter

Description

Position Description:
Serco is excited to continue our support to the Defense Heath Agency (DHA) Medical Coding Program Branch.

The DHA is a joint, integrated Combat Support Agency that enables the Army, Navy, and Air Force medical services to provide a medically ready force to Combatant Commands in both peacetime and wartime.

The essential mission of the DHA Medical Coding Program Branch (DHA-MCPB) is to improve the accuracy and quality of medical coding and documentation across DHA in support of the DHA mission.

The work will encompass all 400 Military Treatment Facilities and Dental clinics assigned to DHA Markets.

The work may include multiple conference calls, virtual meetings, and possible onsite visits to DHA organizational elements inside the continental United States (CONUS) and outside of the continental United States (OCONUS).

This position is contingent upon your ability to obtain and maintain a NACI investigation.

Achieve a minimum 70% passing score on a government approved Medical Coding Auditing Test.
This position is 100% Remote.

Specifically, Medical coding auditing consists of a systematic, unbiased, independent examination of medical documentation and coding to validate that all codes entered into the Military Health System (MHS) systems are in conformity with official coding policies, regulations, requirements, and standards.

The task involves developing or following a disciplined, systematic process that defines what is to be audited and why, how errors are defined and reported, what documentation and official guidance is required, and how results are reported.

You will professionally interact with Medical Treatment Facility (MTF) staff physicians and other coders from different companies regarding coding and documentation rules, policies, procedures, and regulations.

You will obtain clarification of conflicting, ambiguous, or non-specific documentation.

Provide advice, assistance, and technical support to MTF staff, Medical Coders, reviewers, Medical Coding Compliance Specialists, and Medical Coding Trainers as appropriate regarding official coding guidance and regulatory provisions.

In this role, you will:

Verify the accuracy of the diagnosis, procedure, supply codes, modifiers, and sequencing for the professional and institutional (facility) components of Inpatient, External Resource Sharing Agreement (ERSA), Ambulatory Procedure Visit (APV), Observation, Emergency Department (ED), and Outpatient encounters.
Code audited include International Classification of Diseases, Clinical Modification (ICD-CM), International Classification of Diseases, Procedural Classification System (PCS), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and modifiers.
Assign errors IAW the Defense Heath Agency policies, procedures, rules, and standards, and provides clear, concise, official coding guidance, rationale, and reasons for assigning specific errors.
Ensure strict confidentiality of medical records and audit findings.
Provide secondlevel review of coding assignment to ensure compliance with legal and procedural policies to ensure optimal reimbursements while adhering to regulation prohibiting unbundling and other questionable practices.
Review encounters and/or record documentation to identify inconsistencies or discrepancies that may cause inaccurate coding, medicolegal repercussions or impacts quality patient care.
Identify any problems with legibility, abbreviations, etc., and brings to the provider's attention.
Examine records for proper sequence of documents, presence of authorized signatures, and sufficient data is documented that supports diagnosis, treatment administered, and results obtained.
Utilize medical computer software programs to abstract, analyze, and/or evaluate clinical documentation and enter/edit diagnosis and procedure codes.
Write in a clear, concise, organized, and convincing manner for the intended audience; use correct English grammar, punctuation, and spelling; communicate information in a succinct and organized manner; and produce written information.

Qualifications:
To be successful in this role, you will have:

This position is contingent upon your ability to obtain and maintain a NACI clearance.
A minimum of 8 years of medical coding and/or auditing experience in four or more medical, surgical, and ancillary specialties within the past 15 years.
A minimum of one (1) year of performance in the specialty is required to be qualifying. 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.
Four (4) years of the 8 years of required coding experience must involve medical coding auditing functions. Auditing functions include development