Role Description This position is located in the Health Information Management Section (HIMS) at the Central Virginia VA Health Care System (CVHCS). MRTs (Coder) are skilled in classifying medical data from patient health records in the hospital setting, and/or physician-based settings, such as physician offices, group practices, multi-specialty clinics, and specialty centers. Responsibilities - GS-4: - Serve as entry level MRTs (Coder) with close guidance from experienced MRTs (Coder). - Select and assign codes from ICD CM, PCS, CPT, and HCPCS classification systems. - Review record documentation to abstract required data and query clinical staff as appropriate. - Use various computer applications to abstract records, assign codes, and transmit data. - Ensure audit findings have been corrected and refiled. - GS-5: - Serve as developmental level 1 MRTs (Coder) with guidance for complex coding procedures. - Select and assign codes from ICD CM, PCS, CPT, and HCPCS classification systems. - Review record documentation to abstract required data and query clinical staff as appropriate. - Utilize various computer applications to abstract records, assign codes, and transmit data. - Ensure audit findings have been corrected and refiled. - GS-6: - Serve in developmental level 2 positions with intermittent monitoring. - Select and assign codes from ICD CM, PCS, CPT, and HCPCS classification systems. - Review record documentation to abstract required data and query clinical staff as appropriate. - Use various computer applications to abstract records, assign codes, and transmit data. - Ensure audit findings have been corrected and refiled. - GS-7: - Serve as developmental level 3 MRTs (Coder) with minimal monitoring. - Select and assign codes from ICD CM, PCS, CPT, and HCPCS classification systems. - Review and abstract clinical data from the record for documentation of diagnoses and procedures. - Query clinical staff with documentation requirements to support the coding process. - Use various computer applications to abstract records, assign codes, and transmit data. - Ensure audit findings have been corrected and refiled. - GS-8: - Perform comprehensive review of documentation within the health record to assign ICD codes. - Independently review and abstract clinical data from the record for documentation of diagnoses and procedures. - Code all complicated and complex medical/specialty diseases processes and procedures. - Consult with clinical staff for clarification of conflicting or ambiguous clinical data. - Abstract, assign, and sequence codes into encoder software for correct DRG assignment. Qualifications - One year of creditable experience equivalent to the next lower grade level. - Demonstrated Knowledge, Skills, and Abilities: - Ability to analyze health records for pertinent diagnoses and procedures. - Ability to accurately perform the full scope of inpatient coding. - Skill in interpreting and adapting health information guidelines. - Preferred Experience: Inpatient coding experience across multiple medical specialties. Requirements - United States Citizenship. - Proficient in spoken and written English. - One year of creditable experience or an associate's degree in health information technology. - Certification through AHIMA or AAPC. Benefits - Telework available. - Work schedule: 8:00am-4:30pm, Monday-Friday. Physical Requirements - Primarily sedentary work with some walking, bending, and reaching. - Entering data and word processing may result in physical problems from repetitive motion.

• Responsible for accurate, detailed, and thorough medical billing processes • Working in coordination with the team Lead, the Supervisor and Management • The coordinator will work collaboratively with patients and office team members to ensure that billing practices are complete and accurate • Perform duties as assigned in a professional demeanor, which includes interacting with insurance plans, clinics, patients, and team members as needed • Maintain current information on correct and lawful practices for billing payers • Participate in the daily RCM processes, monitoring for accurate and timely completion of team duties • Maintain up to date information on RCM process with National SOPs, processes, and policies • Utilize all available job aids, websites, programs, and resources provided • Support leadership with daily, weekly, monthly reporting needs as required • Maintain department daily productivity goals in completing a set number of accounts while also meeting quality standards as determined by leadership • Identify and communicate with Team Lead / Supervisor any issues including system access, payor behavior, account work-flow inconsistencies or any other RCM related opportunities • Other duties as needed

• Reviews medical record documentation to determine appropriate billing codes • Reviews the documentation in the record to identify all pertinent facts necessary to select comprehensive diagnoses and procedures • Codes evaluation and management to appropriate CPT code and diagnosis to appropriate ICD-9 code • Meets with physicians to review documentation, resolve coding, and secure signatures of unsigned dates of service • Acts as lead person and assists coders with medical terminology and policy interpretation as required • Assists with efforts to increase physician awareness of documentation requirements • Prepares case reports and initiates follow-up for billing process • Performs other duties as assigned

Lead daily shift operations, coordinate resources for optimal procedural flow, support surgical teams with instrumentation, and ensure patient safety through meticulous monitoring and preparation of the operating suite.