Auditing Project Lead jobs in District of Columbia

Position Description

Serco is excited to continue our support to the Defense Heath Agency (DHA) Medical Coding Program Branch. The DHA is a joint, integrated Combat Support Agency that enables the Army, Navy, and Air Force medical services to provide a medically ready force to Combatant Commands in both peacetime and wartime. The essential mission of the DHA Medical Coding Program Branch (DHA-MCPB) is to improve the accuracy and quality of medical coding and documentation across DHA in support of the DHA mission. The work will encompass all 400 Military Treatment Facilities and Dental clinics assigned to DHA Markets. The work may include multiple conference calls, virtual meetings, and possible onsite visits to DHA organizational elements inside the continental United States (CONUS) and outside of the continental United States (OCONUS).

This position is contingent upon your ability to obtain and maintain a NACI investigation; and achieve a minimum 70% passing score on a Government approved Medical Coding Auditing Test.

This position is 100% Remote.

Specifically, Medical coding auditing consists of a systematic, unbiased, independent examination of medical documentation and coding to validate that all codes entered into the Military Health System (MHS) systems are in conformity with official coding policies, regulations, requirements, and standards. The task involves developing or following a disciplined, systematic process that defines what is to be audited and why, how errors are defined and reported, what documentation and official guidance is required, and how results are reported. You will professionally interact with Medical Treatment Facility (MTF) staff physicians and other coders from different companies regarding coding and documentation rules, policies, procedures, and regulations. You will obtain clarification of conflicting, ambiguous, or non-specific documentation. Provide advice, assistance, and technical support to MTF staff, Medical Coders, reviewers, Medical Coding Compliance Specialists, and Medical Coding Trainers as appropriate regarding official coding guidance and regulatory provisions.

In this role, you will:

• Verify the accuracy of the diagnosis, procedure, supply codes, modifiers, and sequencing for the professional and institutional (facility) components of Inpatient, External Resource Sharing Agreement (ERSA), Ambulatory Procedure Visit (APV), Observation, Emergency Department (ED), and Outpatient encounters.
• Codes audited include International Classification of Diseases, Clinical Modification (ICD-CM), International Classification of Diseases, Procedural Classification System (PCS), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and modifiers.
• Assign errors IAW the Defense Heath Agency policies, procedures, rules, and standards, and provides clear, concise, official coding guidance, rationale, and reasons for assigning specific errors.
• Ensure strict confidentiality of medical records and audit findings.
• Provide second-level review of coding assignment to ensure compliance with legal and procedural policies to ensure optimal reimbursements while adhering to regulation prohibiting unbundling and other questionable practices.
• Review encounters and/or record documentation to identify inconsistencies or discrepancies that may cause inaccurate coding, medico-legal repercussions or impacts quality patient care.
• Identify any problems with legibility, abbreviations, etc., and brings to the provider’s attention.
• Examine records for proper sequence of documents, presence of authorized signatures, and sufficient data is documented that supports diagnosis, treatment administered, and results obtained.

Qualifications

To be successful in this role, you will:      

• Make well-informed, effective, and timely decisions.
• Utilize medical computer software programs to abstract, analyze, and/or evaluate clinical documentation and enter/edit diagnosis and procedure codes.
• Write in a clear, concise, organized, and convincing manner for the intended audience; use correct English grammar, punctuation, and spelling; communicate information in a succinct and organized manner; and produce written information.
• Display, courtesy, empathy, and tact, developing and maintaining effective relationships with others.
• Understand and interpret written material, including technical material, rules, regulations, instructions, reports, charts, graphs, or tables.
• Require attention to detail and completeness with a thorough understanding of government rules and regulations, medical coding and reimbursement guidelines, and potential areas of risk for fraud.
• Knowledge of the International Classification of Diseases, Clinical Modification (ICD-CM), and Procedural Coding System (PCS); Healthcare Common Procedure Coding System (HCPCS); and Current Procedural Terminology (CPT).
• Knowledge of reimbursement systems, including Prospective Payment System (PPS) and Diagnostic Related Groupings (DRGs); Ambulatory Payment Classifications (APCs); and Resource-Based Relative Value Scale (RBRVS).
• Advanced knowledge and understanding of industry nomenclature; medical and procedural terminology; anatomy and physiology; pharmacology; and disease processes.
• Practical knowledge of medical specialties; medical diagnostic and therapeutic procedures; ancillary services (includes, but is not limited to, Laboratory, Occupational Therapy, Physical Therapy, and Radiology).
• Thorough understanding of Government rules and regulations regarding medical coding, reimbursement guidelines, and healthcare fraud; commercial reimbursement guidelines and policies; coding audit principles and concepts, and potential areas of risk for fraud and abuse.

Required experience and skills:

• A minimum of one of the following:
  • An associate’s degree in Health Information Management; or
  • A university certificate in medical coding; or
  • At least 30 semester Hours of university/college credit that includes relevant coursework such as anatomy/physiology, medical terminology, health information management, and/or pharmacology.
• Education must be from an accredited educational institution recognized by the American Health Information Management Association (AHIMA) and/or American Academy of Professional Coders (AAPC).
• Coding Certifications - Medical Coding Auditors are required to possess a certification in good standing from each of the following categories:
  • Professional Services Coding Certifications: One of the following recognized professional certifications: Registered Health Information Technician (RHIT); or Registered Health Information Administrator (RHIA); or Certified Professional Coder (CPC); or Certified Outpatient Coder (COC); or Certified Coding Specialist - Physician (CCS-P).
  • Institutional (Facility) Coding Certifications: One of the following recognized Certified Inpatient Coder (CIC), or Certified Coding Specialist (CCS). Other institutional coding certifications will be considered by the DHA-MCPB on a case-by-case basis.
  • AAPC: Certified Professional Medical Coding Auditor (CPMA). Other medical coding auditing certifications will be considered by the DHA-MCPB on a case-by-case basis.
  • National Alliance of Medical Auditing Specialists’ (NAMAS) Certified Evaluation and Management Auditor (CEMA).
• Continuing Education Requirements: Medical coders shall maintain the required continuing education hours in order to maintain current and proper national certification(s) requirements for this position at no expense to the Government

Experience:

• A minimum of 8 years of medical coding and/or auditing experience in four or more medical, surgical and ancillary specialties within the past 15 years.
• A minimum of one (1) year of performance in the specialty is required to be qualifying. Multiple specialties encompass different medical specialties (i.e. Family Practice, Pediatrics, Gastroenterology, OB/GYN, etc.) that utilize ICD, E&M, CPT, and HCPCS codes. Ancillary specialties (PT/OT, Radiology, Lab, Nutrition, etc.) that usually do NOT use E&M codes do not count as qualifying experience.
• Coding experience should include inpatient facility and ambulatory surgery areas. Additionally, coding, auditing and training exclusively for specialties such as home health, skilled nursing facilities, and rehabilitation care will not be considered as qualifying experience.
• Coding experience limited to making codes conform to specific payer requirements for the business office (insurance billing, accounts receivable) is not a qualifying factor.determining compliance with audit standards, communicating with stakeholders during all phases of audit, and reporting on audit findings.
• Four (4) years of the 8 years of required coding experience must involve medical coding auditing functions. Auditing functions include development and execution of audit plan, conducting audit according to audit plan by reviewing required documentation.
• Travel upto 10%
• This position is contingent upon your ability to obtain and maintain a NACI investigation; and achieve a minimum 70% passing score on a Government approved Medical Coding Auditing Test.

If you are interested in supporting and working with our military and sailors and a passionate Serco team- then submit your application now for immediate consideration.  It only takes a few minutes and could change your career!

Company Overview

Serco Inc. (Serco) is the Americas division of Serco Group, plc. In North America, Serco’s 9,000 employees strive to make an impact every day across 100 sites in the areas of Defense, Citizen Services, and Transportation. We help our clients deliver vital services more efficiently while increasing the satisfaction of their end customers. Serco serves every branch of the U.S. military, numerous U.S. Federal civilian agencies, the Intelligence Community, the Canadian government, state, provincial and local governments, and commercial clients. While your place may look a little different depending on your role, we know you will find yours here. Wherever you work and whatever you do, we invite you to discover your place in our world. Serco is a place you can count on and where you can make an impact because every contribution matters.

To review Serco benefits please visit: https://www.serco.com/na/careers/benefits-of-choosing-serco. If you require an accommodation with the application process please email: careers@serco-na.com or call the HR Service Desk at 800-628-6458, option 1. Please note, due to EEOC/OFCCP compliance, Serco is unable to accept resumes by email.

Candidates may be asked to present proof of identify during the selection process. If requested, this will require presentation of a government-issued I.D. (with photo) with name and address that match the information entered on the application. Serco will not take possession of or retain/store the information provided as proof of identity. For more information on how Serco uses your information, please see our Applicant Privacy Policy and Notice.

Serco does not accept unsolicited resumes through or from search firms or staffing agencies without being a contracted approved vendor. All unsolicited resumes will be considered the property of Serco and will not be obligated to pay a placement or contract fee. If you are interested in becoming an approved vendor at Serco, please email Agencies@serco-na.com.

Serco is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.