Role Description This position is located in the Health Information Management (HIM) section at the Chillicothe 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. These coding practitioners analyze and abstract patients' health records, and assign alpha-numeric codes for each diagnosis and procedure. Responsibilities - Assigns codes to documented patient care encounters (inpatient and outpatient) covering the full range of health care services provided by the VAMC. - Selects and assigns codes from the current version of one or more coding systems to include current versions of the International Classification of Diseases (ICD) Clinical Modification (CM) and Procedure Coding System (PCS), Current Procedural Terminology (CPT), and/or Healthcare Common Procedure Coding System (HCPCS). - Adheres to accepted coding practices, guidelines and conventions when choosing the most appropriate diagnosis, operation, procedure, ancillary, or evaluation and management (E/M) code to ensure ethical, accurate, and complete coding. - Monitors ever-changing regulatory and policy requirements affecting coded information for the full spectrum of services provided by the VAMC. - Performs a comprehensive review of the patient health record to abstract medical, surgical, ancillary, demographic, social, and administrative data to ensure complete data capture. - Assists facility staff with documentation requirements to completely and accurately reflect the patient care provided. - Uses skill and knowledge of the organization and structure of the patient health record to capture and justify code assignment. - Utilizes the facility computer system and software applications to code, abstract, record, and transmit data to the national VA database in Austin. - Corrects any identified data errors or inconsistencies in a timely manner to ensure acceptance in the national database within established timelines. Qualifications - United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. - English Language Proficiency: MRTs (Coder) must be proficient in spoken and written English as required by 38 U.S.C. § 7403(f). - Experience: One year of creditable experience that indicates knowledge of medical terminology, anatomy, physiology, pathophysiology, medical coding, and the structure and format of health records. - Education: An associate's degree from an accredited college or university recognized by the U.S. Department of Education with a major field of study in health information technology/health information management, or a related degree with a minimum of 12 semester hours in health information technology/health information management. - Certification: Persons hired or reassigned to MRT (Coder) positions in the GS-0675 series in VHA must have either Apprentice/Associate Level Certification, Mastery Level Certification, or Clinical Documentation Improvement Certification through AHIMA or ACDIS. Requirements - Mastery level certification is required for all positions above the journey level; however, for clinical documentation improvement specialist assignments, a clinical documentation improvement certification may be substituted for a mastery level certification. - Apprentice/Associate Level Certification: This is considered an entry level coding certification and is limited to certification obtained through AHIMA or AAPC. - Mastery Level Certification: This is considered a higher-level health information management or coding certification and is limited to certification obtained through AHIMA or AAPC. - Clinical Documentation Improvement Certification: This is limited to certification obtained through AHIMA or ACDIS. Benefits - Competitive salary and regular salary increases. - 37-50 days of annual paid time off per year (13-26 days of annual leave, 13 days of sick leave, 11 paid Federal holidays per year). - After 12 months of employment, up to 12 weeks of paid parental leave in connection with the birth, adoption, or foster care placement of a child. - After 60 days of employment, full-time employees with a total family income below $144,000 may be eligible for a childcare subsidy up to 25% of total eligible childcare costs for eligible children up to the monthly maximum of $416.66. - Traditional federal pension (5 years vesting) and federal 401K with up to 5% in contributions by VA. - Federal health/vision/dental/term life/long-term care (many federal insurance programs can be carried into retirement). - This position is designated as remote. Remote work is defined as full-time employment conducted outside of a VA facility or in VA-leased spaces.

Review and audit electronic medical records and coding documentation for accuracy, provide corrective actions, and communicate with providers regarding coding guidelines and necessary clarifications to ensure compliance with billing standards.

• Accurately enter ABS data (e.g. Surgeon name, procedure date, discharge disposition, admit diagnosis, POA status, etc.) 95% + Accuracy • Meets or exceeds bill drop dates/AR expectations • Consistently monitors and manages AR to facilitate dropping of pending, old, or problematic accounts of assigned locations in accordance with 30-Day Bill Drop policy. • Accurately reports principal diagnosis in keeping with the most current AHA Coding Clinic and ICD-10-CM/ICD-10CM guidelines. 95% + Accuracy • Manages NCCI and OPPS edits in compliance with industry regulations. Appends modifiers to charges when appropriate. • Identifies and reports to supervisor recurring charge issues that can be addressed with ancillary department managers. • Generates appropriate query selection based on clinical evidence established in the patient medical record. • Maintains established Productivity Standards Same Day Surgery: 6 accounts per hour Observation: 5 accounts per hour. • Emergency Room: 12 accounts per hour. Ancillary encounters: 30 accounts per hour. • Meets or exceeds the expected DRG/APC accuracy rate of 95% Diagnosis and procedural codes applied to accounts result in the appropriate DRG or APC assignment(s)

• Manage insurance claim submissions, payment processing, and billing issue resolution • Prepare and submit clean, accurate claims to insurance companies via electronic systems, mail, or fax • Respond to inquiries from providers, staff, and insurance companies regarding billing concerns • Identify, troubleshoot, and resolve billing discrepancies or complaints • Review accounts and recommend next steps to the Billing Team Lead for resolution or escalation • Perform collection activities including follow-ups, claim corrections, and resubmissions to third-party payers • Process insurance payments and maintain accurate daily deposit records • Generate and maintain daily, weekly, and monthly billing and collection reports • Participate in mandatory monthly staff meetings • Maintain strict confidentiality of patient health information and ensure full compliance with HIPAA regulations