Medical Coder

Required Skills and Abilities

• Responsible for being qualified and competent to perform coding services and activities (there shall be no reimbursement charge for mileage, travel times, meals, parking, etc)
• Must maintain a minimum of 95% accuracy rate on all auditing scores
• Must complete coding activities within five (5) calendar days from assignment
• Possess formal training in anatomy and physiology, medical terminology, pathology and disease processed, pharmacology, health record format and content, reimbursement methodologies and conventions, rules and guidelines for current classification systems (ICD, CPT, HCPCS, E&M, etc.)
• Experience with the Evaluation and Management (E/M) guidelines applicable to the date of service
• Experience and proficiency in 1995 and 1997 E/M documentation guidelines for legacy and retrospective encounters and 2021 and 2023 E/M guidelines for current encounters
• Experience with ensuring coding accuracy and compliance with VA, CPT, and CMS aligned standards, particularly for retrospective coding and accounts referred by billing
• Experience abstracting other identified data items and enter the data into the local EHR encoder program
• Utilize the standardized reasons in the encoder application to communicate specific document information to Billing
• Utilize the national encoder product and EHR, if necessary, to reflect code changes and name(s) of provider(s)
• Reading and reviewing documentation in the electronic health record
• Complete data entry into the encoder
• Provide input to weekly, monthly, and quarterly reports
• Comply with all VA privacy and security requirements
• Apply –GR, G8, QK, QX, QS, QY, and G9 modifiers correctly.
• Apply knowledge of current Diagnostic Coding and Reporting Guidelines for outpatient services.
• Apply knowledge of CPT format, guidelines, and notes to locate the correct codes for all services and procedures performed during the encounter/visit and sequence them correctly
• Apply knowledge of procedural terminology to recognize when an unlisted procedure code must be used in CPT.
• Code in accordance with Correct Coding Initiative (CCI) Bundling Guidelines.
• Use the CMS Common Procedural Coding Systems (HCPCS), where appropriate.
• Be able to code inpatient discharges when requested by VHA; e.g., quarterly census, etc.
• Must complete the yearly privacy and security processes and training as required by the VAHCS.

Education and Experience

Physical Requirements

• Prolonged periods of sitting at a desk and working on a computer