Medical Coding Compliance Specialist

Description Engility is seeking a Medical Coding Compliance Specialist, who takes pride in their work, to contribute to the continued success of our DHA programs at Travis Air Force Base, CA.  In this role you will be : Providing analysis and auditing of medical coding  Investigating and resolving issues and variance with policy Make compliance and process related recommendations on medical coding issues Provide research, and other support services to ensure observance with official coding policies, regulations, requirements, and standards.  Ensure revenue integrity consists by providing analysis, auditing, investigation, recommendations, research, and other support to prevent lost revenue from healthcare operations. Participate in process improvement efforts by  maintaining a weekly issues log in accordance with the AFMS Coding Manual, to be received by the AFMS MCPO. Take required continuing education classes in order to maintain current and proper national certification(s) requirements for this position Apply your understanding of government rules and regulations regarding medical coding, reimbursement guidelines, and healthcare fraud; commercial reimbursement guidelines and policies; coding audit principles and concepts, and potential areas of risk for fraud and abuse. Grow your knowledge of revenue cycle management, project management concepts, business analysis, training methods, clinical documentation improvement, and continuous process improvement processes.   Qualifications Education:  To qualify for this job the applicant must have an associate's degree in Health Information Management, a university certificate in medical coding,  at least 30 semester hours' university/college credit that includes relevant coursework such as anatomy/physiology, medical terminology, health information management, and/or pharmacology; OR Completion of American Health Information Management Association (AHIMA) and/or American Academy of Professional Coders (AAPC) exam preparation courses. Coding certification may be accepted in lieu of university  credit. Experience: 10 or more years of medical coding and/or auditing experience in two or more medical, surgical, and ancillary specialties  At least 5 years of experience training auditors, coders, and/or providers, or a minimum of 3 years of training experience in a military coding environment.  Coding certification in good standing from each of the following: a) Professional Services Coding Certifications: Registered Health Information Technician (RHIT); Registered Health Information Administrator (RHIA); Certified Professional Medical Coding Auditor (CPMA); Certified Professional Coder (CPC); Certified Outpatient Coder (COC); or Certified Coding Specialist - Physician (CCS-P). b) Institutional (Facility) Coding Certifications:  Certified Inpatient Coder (CIC), Certified Coding Specialist (CCS). Other institutional coding certifications will be considered by the AFMS MCPO c) Compliance Certifications: Certified Professional Compliance Officer (CPCO) from AAPC; Certified in Healthcare Compliance (CHC) or Certified Compliance & Ethics Professional (CCEP) from the Healthcare Compliance Association (HCCA). Other compliance certifications will be considered by the AFMS MCPO  Desired Qualifications:  Knowledge of the International Classification of Diseases, Clinical Modification (ICD-CM), & Procedural Coding System (PCS); Healthcare Common Procedure Coding System (HCPCS); and Current Procedural Terminology (CPT). Advanced knowledge of reimbursement systems, including Prospective Payment System (PPS) and Diagnostic Related Groupings (DRGs); Ambulatory Payment Classifications (APCs); and Resource-Based Relative Value Scale (RBRVS). Understanding of industry nomenclature; medical and procedural terminology; anatomy and physiology; pharmacology; and disease processes. Practical knowledge of medical specialties; medical diagnostic and therapeutic procedures; ancillary services (includes, but is not limited to, Laboratory, Occupational Therapy, Physical Therapy, Radiology; revenue cycle management.) 1814089
Salary Range: NA
Minimum Qualification
11 - 15 years

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