Medical Coding Auditor

Medical Coding Auditor

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 Coding Auditor, to support a federal client. The Auditor will have expertise in International Classification of Diseases (ICD), Current Procedural Terminology (CPT), and the Healthcare Common Procedure Coding System (HCPCS). The Medical Coding Auditors will serve as experts of current coding conventions and guidelines related to professional and facility coding and perform audits of encounters to identify areas of non-compliance in coding.

This is a Part Time role, auditors must commit to a minimum of 5 hours up to 20 hours per week, scheduled at your discretion from Monday through Sunday weekly.

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.

Responsibilities and Duties:

• Applies comprehensive knowledge of medical terminology, anatomy & physiology, disease processes, treatment modalities, diagnostic tests, medications, procedures as well as the principles and practices of health services and the organizational structure to ensure proper code selection.
• Reviews assigned codes from the current version of several coding systems to include current versions of the International Classification of Diseases (ICD), Current Procedural Terminology (CPT), and/or Healthcare Common Procedure Coding System (HCPCS).
• Applies guidelines specific to certain diagnoses, procedures, and other criteria used to classify patients under the Veterans Equitable Resource Allocation (VERA) program that categorizes all VA patients into specific classes representing their clinical conditions and resource needs.
• Monitors ever-changing regulatory and policy requirements affecting coded information for the full spectrum of services provided by the VAMC.
• Assists facility staff with documentation requirements to completely and accurately reflect the patient care provided.
• Reviews, analyzes, and reports performance monitors for PTF, PCE, VERA and Non-VA Medical Care (purchased care) coding.
• Performs other duties as assigned.

Required Skills and Abilities:

• 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.
• 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. Research complex coding issues and participates in process improvements related to coding.
• 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.
• Requires six additional months of creditable experience that is paid or non-paid employment equivalent to a MRT (Coder).

Education and Experience:

• Minimum of Three (3) years' experience reviewing records
• An associate's degree or higher in Health Care
• One year of creditable experience that indicates knowledge of medical terminology, anatomy, physiology, pathophysiology, medical coding, and the structure and format of health records
• At least two (2) years of Veteran Affairs or other relevant coding experience, either as a Department of Veterans Affairs employee or with another Government contractor supporting The Department of Veterans Affairs
• Experience using VIRR/WebVIRR
• We are looking for coders who can commit to a minimum of 20 hours per week, scheduled at your discretion from Monday through Sunday weekly

Certifications Required:

• Apprentice/Associate level Certification through AHIMA or AAPC
• Mastery Level Certification through AHIMA or AAPC
• Clinical Documentation Improvement Certification through AHIMA or ACDIS

Physical Requirements:

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