• Examines medical records to determine the proper ICD (diagnosis) and CPT (procedure codes) to be assigned • Utilizes coding tools & resources to verify the correctness of CPT and ICD codes assigned • Abstracts data including providers, injury info, quality measures, and others as needed • Maintains knowledge of current trends and practices in coding principles and government regulations through reading materials and/or attendance at educational meetings or seminars • Maintains appropriate certification • Communicates with coworkers and physicians to resolve and clarify questions and documentation discrepancies • Communicates risk management concerns to appropriate parties • Completes priority accounts (Holds) daily • Refers complex issues to designated work queues • Participates in coder specific training and education based on audit metrics and trends • Review and analyze content of medical record to accurately assign ICD diagnosis and procedure codes; CPT procedure codes and modifiers according to national coding guidelines, USACS policies and SOPs • Answer coding and abstracting questions from coding leadership, compliance, clinicians, etc. • Maintain coding accuracy rate of ≥ 95% • Maintain coding productivity (Milestone based standards) rate of ≥ 95% • Maintain minimum of 15 CEUs per quarter either through Nthrive and/or other company sponsored webinars and programs • Accurately identify and enter core abstracting elements such as physician and APP attributions • Identify documentation trends and topics for education/feedback to physicians and APPs • Keep current with coding and industry changes through participation in educational opportunities • Thorough understanding of updates from intermediaries, carriers, government agencies, third party payers to ensure proper documentation, coding and compliance • Thorough knowledge of coding guidelines, medical terminology, anatomy/physiology, reimbursement schemes, payor specific guidelines • Assists with special projects as needed and performs related duties as assigned

Role Description This position is in the Health Information Management (HIM) section at the VA St. Louis Health Care System (VASTLHCS). 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. Duties and responsibilities include but are not limited to: - Assigns codes to documented patient care encounters (inpatient facility and/or professional services) covering the full range of health care services provided by the VAMC. - Selects and assigns codes from the current version of several coding systems including current versions of the International Classification of Diseases (ICD), 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 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. Patient health records may be paper or electronic. - Assists facility staff with documentation requirements to completely and accurately reflect the patient care provided; provides technical support in the areas of regulations and policy, coding requirements, resident supervision, reimbursement, workload, accepted nomenclature, and proper sequencing. - Utilizes the facility computer system and software applications to correctly code, abstract, record, and transmit data to the national VA database in Austin. Qualifications - 3+ years of experience in Inpatient coding and/or Pro Fees. - Basic Requirements: - 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 one of the following: - Apprentice/Associate Level Certification through AHIMA or AAPC. - Mastery Level Certification through AHIMA or AAPC. - Clinical Documentation Improvement Certification through AHIMA or ACDIS. Requirements - Work Schedule: Monday - Friday from 8:00am-4:30pm - Compressed/Flexible: Available - Recruitment Incentive (Sign-on Bonus): Not Authorized - Permanent Change of Station (Relocation Assistance): Not Authorized - Pay: Competitive salary and regular salary increases. Higher step rate may be determined based on qualifications or special needs of the VA. - Paid Time Off: 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). - Parental Leave: 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. - Child Care Subsidy: 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. - Retirement: Traditional federal pension (5 years vesting) and federal 401K with up to 5% in contributions by VA. - Insurance: Federal health/vision/dental/term life/long-term care (many federal insurance programs can be carried into retirement). - Telework: This is a remote position. - Virtual: This is not a virtual position. Benefits - Selected applicants may qualify for credit toward annual leave accrual, based on prior work experience or military service experience.

• Medical Billing: Manage the full medical billing cycle, including claim submission, insurance claim follow-up, payment posting, denial resolution, and overall billing workflow. • Patient Communication: Handle inbound and outbound calls professionally. • Respond to billing inquiries from patients and insurance companies. • Provide timely follow-up regarding outstanding balances or claim-related concerns. • Athena EMR & Documentation: Accurately document billing activities and communications in Athena EMR. • Maintain organized billing records. • Ensure timely follow-up on outstanding accounts. • Team Collaboration: Work closely with the office team to resolve billing questions, account discrepancies, and other payment-related issues.

Role Description Provides support for medical coding activities, including ensuring that ICD-10 and CPT codes are reported accurately to maintain compliance, and minimize risk and denials. Contributes to overarching strategy to provide quality and cost-effective member care. - Performs on-going member medical chart reviews. Abstracts and reports ICD-10 and CPT diagnosis codes accurately and in compliance with established coding and billing principles - minimizing risk and denials. - Demonstrates understanding of current provider office billing practices - ensuring that diagnosis and CPT codes are submitted accurately. - Documents results/findings from chart reviews and provides feedback to leadership, providers and office staff. - Provides training and education to provider network regarding risk adjustment and coding updates related to risk adjustment. - Builds positive relationships between providers and the business by providing coding assistance as needed. - Facilitates administrative duties such as planning, chart reviews scheduling, medical records procurement, provider training and education. - Assists in coordination of management activities with other departments including finance, revenue analytics, claims, encounters and enterprise/plan medical directors. - Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks and participating in professional societies related to medical coding in the managed care industry. Qualifications - At least 2 years medical coding experience, or equivalent combination of relevant education and experience. - Certified Professional Coder (CPC). - Certified Coding Specialist (CCS). - Latest Centers for Medicare and Medicaid Services (CMS) and American Hospital Association (AHA) clinic coding knowledge. - Ability to maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA). - Ability to effectively interface with staff, clinicians, and management. - Excellent verbal and written communication skills. - Ability to establish and maintain positive and effective work relationships with coworkers, members, providers and all other customers. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications - Certified Risk Adjustment Coder (CRC). - Certified Professional Payer – Payer (CPC-P). - Certified Coding Specialist – Physician Based (CCS-P). - Familiar with HCC (Hierarchical Condition Categories) Risk Adjustment Model. - Background in supporting risk adjustment management activities and clinical informatics. - Experience with risk adjustment data validation. Benefits Molina Healthcare offers a competitive benefits and compensation package. Company Description Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.