SUMMARY: Responsible for assignment of
accurate Evaluation and Management (E&M) codes, ICD diagnoses, current
procedural terminology (CPT) and Healthcare Common Procedure Coding System
(HCPCS), modifiers and quantities derived from medical record documentation (paper
or electronic) for outpatient encounters. Trains and educates MTF staff on
coding issues and plays a significant role in coding compliance activities.
Position requires excellent computer/communication skills for provider
and staff interactions.
Knowledge of anatomy/physiology and disease process, medical terminology,
coding guidelines (outpatient), documentation requirements, familiarity with medications
and reimbursement guidelines; and encoder experience.
Candidate must have ability to handle multiple projects and appropriately
prioritize tasks to meet deadlines.
Education/Certification. The following
are recognized certifications:
Registered Health Information Technologist (RHIT), Registered Health
Information Administrator (RHIA), Certified Professional Coder (CPC) CCS-P
(Certified Coder Specialist – Physician (CCS-P) with the appropriate level of
An accrediting institution recognized by the American Health Information
Management Association (AHIMA) and/or
American Academy of Professional Coders (AAPC) must accredit education.
CONTINUED EDUCATION REQUIREMENTS:
Contract medical coders will obtain the
required continued education hours at no expense to the government in order to maintain
current and proper national certification(s) required for the position.
A minimum of three year experience in the outpatient setting (physician’s
office or ambulatory surgery centers) within the last five years, including
assignment of E&M, 3 CPT, and HCPCS codes. Multiple specialties encompass
different medical specialties (i.e.Family Practice, Pediatrics,
Gastroenterology, OB/GYN, etc.) that utilize ICD, E&M, CPT, and HCPCS
specialties (PT/OT, Radiology, Lab, Nutrition, etc.) that usually do NOT use
E&M codes do not count as qualifying experience. Additionally, coding,
auditing and training exclusively for specialties such as home health, skilled
nursing facilities, and rehabilitation care will not be considered as
o Coding experience
limited to making codes conform to specific payer requirements for the business
office (insurance billing, accounts receivable) is not a qualifying factor.
o Two years of
outpatient/ambulatory surgery experience may be qualifying if received in a
military medical facility.
Work Environment/Physical Requirements.
The work is primarily sedentary. Requirements may include prolonged
walking, standing, sitting or bending. Carrying or lifting of medical records
may be required daily. Use of one or more computer programs and monitors may be
Responsible for assignment of accurate E&M, ICD, CPT and HCPCS codes
and modifiers from medical record documentation.
Identifies and abstracts information from medical records (paper or
electronic) for special studies and audits, internal and external.
Interacts with MTF staff to ensure documentation is clear and supports
Educates MTF staff through individual or group in-services and training
Maintains a delinquency report of missing records in order to facilitate
completion of work within the required Air Force thresholds.