Job details
Salary $48,378 - $62,894 a year job type full-time
Full job description
Duties
Summary
The john j pershing va medical center is currently seeking a highly qualified medical records technician (coder-outpatient).
Responsibilities
This position is located in the health information management (him) section at the john jPershing va medical centerMrts (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 centersThese coding practitioners analyze and abstract patients` health records, and assign alpha-numeric codes for each diagnosis and procedureTo perform this task, they must possess expertise in international classification of diseases (icd), current procedural terminology (cpt), and the healthcare common procedure coding system (hcpcs)Mrt (coder) may also provide education related to coding and documentation.
Duties include but are not limited to:
Assigns codes to documented patient care encounters (outpatient facility and/or professional services) covering the full range of health care services provided by the vamcPatient encounters are often complicated and complex requiring extensive coding expertiseApplies advanced knowledge of medical terminology, anatomy & physiology, disease processes, treatment modalities, diagnostic tests, medications, procedures as well as the principles and practices of health services and the organizational structure to ensure proper code selection.
Selects and assigns codes from the current version of several coding systems to include 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 codingAlso applies codes based on guidelines specific to certain diagnoses, procedures, and other criteria used to classify patients under the veterans equitable resource allocation (vera) program that categorizes all va patients into specific classes representing their clinical conditions and resource needs.
Monitors ever-changing regulatory and policy requirements affecting coded information for the full spectrum of services provided by the vamcTimely compliance with coding changes is crucial to the accuracy of the facility database as well as all cost recovery programs.
Performs a comprehensive review of the patient health record to abstract medical, surgical, ancillary, demographic, social, and administrative data to ensure complete data capturePatient health records may be paper or electronicThe abstracted data has many purposes, for example, to profile the facility services and patient population, to determine budgetary requirements, to report to accrediting and peer review organizations, to bill insurance companies and other agencies, and to support research programs.
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 sequencingInsures provider documentation is complete and supports the diagnoses and procedures codedDirectly consults with the professional staff for clarification of conflicting or ambiguous clinical dataReports incorrect documentation or codes in the electronic patient health record.
Expertly searches the patient health record to find documentation justifying code assignment based on an expanded knowledge of the organization and structure of the patient record.
Utilizes the facility computer system and software applications to correctly 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 va database within established timelinesIndependently researches references to resolve any questionable code errors; contacts supervisor as appropriate.
Identifies the principal diagnosis and principal procedure (when applicable) for every outpatient discharge; also identifies significant complications and/or co-morbidities treated or impacting treatment to correctly determine the proper diagnosis related group (drg)Upon patient admission to the community living center/nursing home care unit, codes the admission diagnosis for use by unit staffAll diagnoses and procedure codes are selected from the current version of the icd coding system.
Work schedule: monday- friday 0800-1630
Telework: ad hoc as needed
Virtual: this is a virtual position for highly qualified candidates.
Position title/functional statement #:medical records technician (coder-outpatient)/pdfs-08
Fi nancial disclosure report: not required
Travel required
Not required
Supervisory status
No
Promotion potential
None
Job family (series)
0675 medical records technician
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Requirements
Requirements
Conditions of employment
You must be a u.sCitizen to Apply Now
All applicants tentatively selected for va employment in a testing designated position are subject to urinalysis to screen for illegal drug use prior to appointmentApplicants who refuse to be tested will be denied employment with va.
Selective service registration is required for males born after 12/31/1959
You may be required to serve a probationary period
Subject to a background/security investigation
Must be proficient in written and spoken english
Selected applicants will be required to complete an online onboarding process
Participation in the seasonal influenza and coronavirus disease 2019 (covid-19) vaccination programs are requirements for all department of veterans affairs health care personnel (hcp)
Qualifications
Applicants pending the completion of educational or certification/licensure requirements may be referred and tentatively selected but may not be hired until all requirements are met.
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.
Experience/education: one year of creditable experience that indicates knowledge of medical terminology, anatomy, physiology, pathophysiology, medical coding, and the structure and format of a health recordsOr educationAn associate`s degree from an accredited college or university recognized by the u.sDepartment 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 (e.g., courses in medical terminology, anatomy and physiology, medical coding, and introduction to health records); or completion of an ahima approved coding program, or other intense coding training program of approximately one year or more that included courses in anatomy and physiology, medical terminology, basic icd diagnostic/procedural, and basic cpt codingThe training program must have led to eligibility for coding certification/certification examination, and the sponsoring academic institution must have been accredited by a national u.sDepartment of education accreditor, or comparable international accrediting authority at the time the program was completed; or e xperience/education combinationEquivalent combinations of creditable experience and education are qualifying for meeting the basic requirementsThe following educational/training substitutions are appropriate for combining education and creditable experience: (a) six months of creditable experience that indicates knowledge of medical terminology, general understanding of medical coding and the health record, and one year above high school, with a minimum of 6 semester hours of health information technology courses(b) successful completion of a course for medical technicians, hospital corpsmen, medical service specialists, or hospital training obtained in a training program given by the armed forces or the u.sMaritime service, under close medical and professional supervision, may be substituted on a month-for-month basis for up to six months of experience provided the training program included courses in anatomy, physiology, and health record techniques and proceduresAlso, requires six additional months of creditable experience that is paid or non-paid employment equivalent to a mrt (coder).
Certification: persons hired or reassigned to mrt (coder) positions in the gs-0675 series in vha must have either (1), (2), or (3) below: (1) apprentice/associate level certification through ahima or aapc(2) mastery level certification through ahima or aapc(3) clinical documentation improvement certification through ahima or acdis
Grade determination: medical records technician (coder - outpatient):
Gs8
ExperienceOne year of creditable experience equivalent to the next lower grade level
Ksas: iAbility to analyze the health record to identify all pertinent diagnoses and procedures for coding and to evaluate the adequacy of the documentationThis includes the ability to read and understand the content of the health record, the terminology, the significance of the findings, and the disease process/pathophysiology of the patientIiAbility to accurately perform the full scope of outpatient coding, including ambulatory surgical cases, diagnostic studies and procedures, and outpatient encounters, and/or inpatient professional fee services codingIiiSkill in interpreting and adapting health information guidelines that are not completely applicable to the work or have gaps in specificity, and the ability to use judgment in completing assignments using incomplete or inadequate guidelines
May qualify based on being covered by the grandfathering provision as described in the va qualification standard for this occupation (only applicable to current vha employees who are in this occupation and meet the criteria).
References: va handbook 5005 /122 part ii appendix g57
The full performance level of this vacancy is gs8.
Physical requirements: light lifting, under 15 lbs., moderate carrying, 15-44 lbs., reaching above shoulder, use of fingers, standing 4-6 hours; hearing, aid permittedDuties require extensive use of fingers to perform keyboarding and the ability to hear requests by phone and in personVersion must be adequate to read and prepare documents.
Education
Important: a transcript must be submitted with your application if you are basing all or part of your qualifications on education.
Note: only education or degrees recognized by the u.sDepartment of education from accredited colleges, universities, schools, or institutions may be used to qualify for federal employmentYou can verify your education here: http://ope.ed.gov/accreditation/If you are using foreign education to meet qualification requirements, you must send a certificate of foreign equivalency with your transcript in order to receive credit for that educationFor further information, visit: http://www.ed.gov/about/offices/list/ous/international/usnei/us/edlite-visitus-forrecog.html.
Additional information
Receiving service credit or earning annual (vacation) leave: federal employees earn annual leave at a rate (4, 6 or 8 hours per pay period) which is based on the number of years they have served as a federal employeeVa may offer newly-appointed federal employee`s credit for their job-related non-federal experience or active duty uniformed military serviceThis credited service can be used in determining the rate at which they earn annual leaveSuch credit must be requested and approved prior to the appointment date and is not guaranteed.
This job opportunity announcement may be used to fill additional vacancies.
It is the policy of the va to not deny employment to those that have faced financial hardships or periods of unemployment.
This position is in the excepted service and does not confer competitive status.
Va encourages persons with disabilities to applyThe health-related positions in va are covered by title 38, and are not covered by the schedule a excepted appointment authority.
Veterans and transitioning service members: please visit the va for vets site for career-search tools for veterans seeking employment at va, career development services for our existing veterans, and coaching and reintegration support for military service members.
If you are unable to apply online or need to fax a document you do not have in electronic form, view the following link for information regarding an alternate application.
How you will be evaluated
You will be evaluated for this job based on how well you meet the qualifications above.
In describing your experience, please be clear and specificWe may not make assumptions regarding your experienceYour application, résumé, c.v., and/or supporting documentation will be verifiedPlease follow all instructions carefullyErrors or omissions may affect consideration for employment.
Experience refers to paid and unpaid experience, including volunteer work done through national service programs (e.g., peace corps, americorps) and other organizations (e.g., professional; philanthropic; religions; spiritual; community; student; social)Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employmentYou will receive credit for all qualifying experience, including volunteer experience.
Background checks and security clearance
Security clearance
Other
Drug test required
No
Position sensitivity and risk
Non-sensitive (ns)/low risk
Trust determination process
Suitability/fitness
Required documents
Required documents
To apply for this position, you must provide a complete application package which includes:
Resume
Va form 10-2850c application for associated health occupations can be found at: https://www.va.gov/vaforms/medical/pdf/vha-10-2850c-fill.pdf.
(not required at time of application)
The following documents are accepted, and may be required if applicable to your eligibility and/or qualifications for this positionPlease use this checklist to ensure you have included all documents required for your application, such as a copy of your transcript (if using education to qualify), sf-50`s (current/former federal employees), etc.
Dd-214/ statement of service
Disability letter (va)
License
Ksas - highly suggested in documenting the knowledge, skills and abilities for the grade level that you wish to be considered for.
Professional certification
Resume
Sf-15
Sf-50/ notification of personnel action
Transcript
Veterans` preference: when applying for federal jobs, eligible veterans should claim preference for 5pt (tp), 10pt (cp/cps/xp), or for sole survivor preference (ssp) in the questionnaireYou must provide a legible copy of your dd214(s) which shows dates and character of service (honorable, general, etc.)If you are currently serving on active duty and expect to be released or discharged within 120 days you must submit documentation related to your active duty service which reflects the dates of service, character of service (honorable, general, etc.), and dates of impending separationAdditionally, disabled veterans and others eligible for 10-point preference (such as widows or mothers of eligible veterans) must also submit an sf-15 `application for 10 point veteran preference` with required proof as stated on the formDocumentation is required to award preferenceFor more information on veterans` preference, please visit feds hire vets - veterans - job seekers - veterans` preference.
If you are relying on your education to meet qualification requirements:
Education must be accredited by an accrediting institution recognized by the u.sDepartment of education in order for it to be credited towards qualificationsTherefore, provide only the attendance and/or degrees from schools accredited by accrediting institutions recognized by the u.sDepartment of education.
Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.
Benefits
Benefits
A career with the u.sGovernment provides employees with a comprehensive benefits packageAs a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewardingOpens in a new windowlearn more about federal benefits.
Review our benefits
Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time, or intermittentContact the hiring agency for more information on the specific benefits offered.
Help
This job is open to
The public
U.sCitizens, nationals or those who owe allegiance to the u.s.
