Hipaa Certified Medical Coder - 12 Month Contract (RFO-15-009)

HIPAA CERTIFIED MEDICAL CODER

CONTRACT: 12 months (W2); starting on or around Nov 23, 2015

LOCATION: West Sacramento, CA 95605

JOB NUMBER: RFO-15-009

PROJECT OVERVIEW:

- Transition from ICD-9 to ICD-10-CM and ICD-10-PCS

JOB DESCRIPTION:

- SOME OF THE ACTIVITIES THAT THIS TRANSITION WILL REQUIRE POST-IMPLEMENTATION INCLUDE THE FOLLOWING:
- Ongoing identification of and updates to policies that depend on diagnosis and procedure codes
- Continued training and education for all impacted providers, stakeholders, and staff members of other departments
- Providing direction for ICD-10 diagnosis and other HIPAA-identified codes sets, as well as promote industry-recognized standardization of code set utilization, particularly as information systems are revised or developed
- A SUBSTANTIAL COMPONENT OF THE PROJECT WILL BE THE CREATION OF MEANINGFUL WAYS TO USE AND UNDERSTAND ICD-10 DIAGNOSIS AND PROCEDURE CODES. Standardization of the code sets supports clinical quality measures and promotes quality analysis requirements found in the Patient Protection and Affordable Care Act. This will require extensive education and outreach so that program, policy, rate development and IT staff understand the potential impact to their respective business areas.

TOP DAILY RESPONSIBILITIES:

- CERTIFIED MEDICAL CODERS WORK WITH PROGRAM POLICY LEADS TO REINFORCE CORRECT CODING AND STANDARDIZE THE USE OF MEDICAL CODES ACROSS STATE PROGRAMS. They are responsible for intelligently populating the codes in the code Management Tool database, which for the first time, allows program policy leads to critically evaluate usage of all codes across multiple program areas. This encourages collaboration among programs and supports reusable architecture in the modularity condition as noted. It promotes discussion between programs that use the same or similar coding solutions.
- CERTIFIED MEDICAL CODERS WILL PROMOTE THE ADOPTING OF INDUSTRY STANDARDS AND KNOWLEDGE OF MEDICAID CODE USAGE BY MONITORING THE NATIONAL MEDICAID EDI HIPAA (NMEH) WORKGROUP. The biggest contribution to Medicaid Information Technology Architecture (MITA) maturity is in the reporting and interoperability conditions, which contribute to standardization and reuse among all programs. This will have a big impact on data quality and clinical measurements. Other MITA conditions are met indirectly, as the coding work contributes to other projects that adhere to MITA such as ICD-10 M&O and Medicaid Management Information Systems (MMIS) replacement of California's Legacy system.

MANDATORY QUALIFICATIONS:

- Knowledge of ICD-9 and ICD-10, Current Procedure Terminology (CPT), and Health Care Procedure Coding Standardization/Systems (HCPCS) Level II coding standards
- Knowledge of Centers for Medicare and Medicaid Services (CMS) 1500 and Universal Billing (UB) UB-04 claim forms and billing requirements
- Knowledge of all medical coding standards and code sets
- Knowledge of Standard Setting organizations: American Medical Association (AMA), National Uniform Claims Committee (NUCC), National Uniform Billing Committee (NUBC), Centers for Medicare and Medicaid Services (CMS)
- Knowledge of Medicaid, Medicare, and third-party payer requirements
- Excellent written and oral communication skills
- Certified Medical Coding Expertise Consulting Services
- Strong computer skills, including knowledge of MS Word, MS Excel, and MS PowerPoint
- Minimum 3 years' medical coding experience in a hospital, clinic outpatient setting, or health insurance carrier environment

The proposed Certified Medical Coder MUST BE CERTIFIED by the American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC) as an ICD-10 certified coder or instructor/trainer, and have current certification in at least one of the following categories:

Certified Coding Specialist (CCS)

Certified Coding Specialist - Physician (CCS-P)

Certified Procedural Coder (CPC)

DESIRABLE QUALIFICATIONS:

- Knowledge of Medi-Cal billing policies and requirements
- Experience preparing training materials and executing training forums (classroom, etc.)
- Knowledge of MS Access, MS Project
- Experience in state policy and regulation formation
- Preferred BA/BS in a health related field
- Prior experience in performing ICD-10 analysis
- Working knowledge of General Equivalency Mappings (GEMs)
- Knowledge of 4010 conversion to 5010 and how it affects ICD-9 to ICD-10
- Knowledge of Health Insurance Portability and Accountability Act (HIPAA)