• Reviews medical record documentation to determine appropriate billing codes and necessary documentation • Codes evaluation and management to appropriate CPT code and diagnosis to appropriate ICD-9 code • Meets with physicians to review documentation and secure signature of unsigned dates • Assists with efforts to increase physician awareness of documentation requirements • Prepares case reports and initiates follow-up for billing process

• responsible for reviewing and analyzing documentation present in the medical record for inpatient, outpatient and/or professional services to assign diagnoses/procedure codes • Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines

• Responsible for timely and compliant Private Duty billing, authorizations, and reimbursement for designated region • Work directly with revenue cycle director, billing compliance coordinator, agencies, and intermediary to facilitate billing claims • Obtain authorizations as needed • Prepare, audit, and submit claims electronically for appropriate payment • Follow up on outstanding claims and take appropriate action for timely payment • Collect necessary information to prepare claims, coordinating with agencies when appropriate • Bill and submit clean claims electronically and follow up with the Payer • Process, collect, and manage account payments • Monitor claims daily, report totals • Research, correct, and re-submit rejected and denied claims • Follow-up on corrections and report adjustments using revenue cycle management tool • Monitor and maintain assigned accounts • Review billing reports to maintain accurate AR balances • Document follow-ups on claim outstanding balance until final resolution is reached • Keep accurate and orderly records for all billing and accounts receivable activity • Conduct pre-billing audits as assigned • Proactive in identifying potential reimbursement issues while ensuring effective problem resolution • Coordinate with the Agency and Billing Compliance Coordinator on relevant process issues impacting billing • Report any billing issues that develop into trends to immediate supervisor • Answer questions from patients, agency staff, and insurance companies • Interpret and process Explanation of Benefits when needed • Professionally make outbound calls while improving customer relations • Maintain knowledge of current industry standards related to billing and cognizant of new regulations

Role Description This position is located in the Health Information Management (HIM) section at the Robley Rex VA Medical Center. 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. - This job opportunity announcement (JOA) will be used to fill one (1) full-time and permanent Supervisory Medical Records Technician (Coder) vacancy at the Louisville, KY Veteran Affairs Medical Center (VAMC), with Business Office Service. - MRTs (Coder) analyze and abstract patients' health records and assign alpha-numeric codes for each diagnosis and procedure. - Must possess expertise in: - International Classification of Diseases (ICD) - Current Procedural Terminology (CPT) - Healthcare Common Procedure Coding System (HCPCS) - Provide education related to coding and documentation. - Supervisory MRTs (Coder) are responsible for: - Supervising coding staff at the facility level. - Performing all duties of a MRT (Coder). - Administrative management and direction of coding staff. - Program management of a coding section/unit to ensure performance monitors are established and met. - Evaluating performance of subordinate staff. - Approving sick and annual leave requests. - Identifying educational or training needs. - Resolving employee complaints and taking disciplinary actions, when necessary. - Informing higher-level management of anticipated vacancies or increases in workload. - Recommending employees for promotions, reassignments, recognitions, retention or release of probationary employees, or other changes of assigned personnel. - Making decisions on the selection of employees for vacant or new positions. - Serving as an expert coding resource to ensure accuracy and integrity of all coding. - Collaborating with revenue, compliance, and other departments to support coding accuracy consistent with official guidelines. - Resolving claim edits referred to coding management and monitoring reports for outstanding services, rejects, or un-coded episodes of care. - Ensuring claim denials related to coding errors are resolved, and/or daily coding rejects are corrected for accurate billing and data collection. - Providing education to clinical and coding staff. - Assessing current audit findings and evaluating impact to coding and documentation practices. - Overseeing the reporting of coding and documentation audit results to leadership. - Collecting and preparing data for studies involving inpatient stays and outpatient encounters for clinical evaluation purposes. - Preparing and maintaining a variety of complex records and reports as requested. - Creating and monitoring outpatient reports, inpatient case mix reports, top DRGs, and key performance indicators to identify patterns, trends, and variations. - Investigating and evaluating potential causes for changes or problems and collaborating with appropriate staff to effect resolution or explain variances. - Participating in the formulation of objectives and strategies utilizing coded data to support goals for patient care, teaching, research, and optimizing management of resources. - Supervisory MRTs whose assignments involve two or more MRT specialty areas will be assigned the parenthetical title for the predominant specialty area. Qualifications - United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. - Experience or Education: - One year of creditable experience indicating knowledge of medical terminology, anatomy, physiology, pathophysiology, medical coding, and the structure and format of health records. - OR An Associate's degree from an accredited college or university with a major field of study in health information technology/health information management, or related degree with a minimum of 12 semester hours in health information technology/health information management. - OR Completion of an AHIMA approved coding program, or other intense coding training program of approximately one year or more. - OR Experience/Education Combination. - Certification: Persons hired or reassigned to MRT (Coder) positions in the GS-0675 series in VHA must have either: - 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: See VA Directive and Handbook 5019, Employee Occupational Health Service. - English Language Proficiency: MRTs (Coder) must be proficient in spoken and written English as required by 38 U.S.C. § 7403(f). Requirements - Grade Determinations: - GS-10 Supervisory Medical Records Technician (Coder): One year of creditable experience equivalent to the next lower grade level. - Experience is only creditable if it is directly related to the position to be filled. - Employees at this level must have a mastery level certification. - Mastery Level Certification must represent a comprehensive competency in the occupation. Benefits - Relocation/Recruitment Incentives: Not authorized. - Permanent Change of Station (PCS): Not authorized. Company Description IMPORTANT: A transcript must be submitted with your application if you are basing all or part of your qualifications on education. Note: Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment.