[Hiring] Medical Records Technician (Coder-Outpatient) @VA Northeast Ohio Healthcare System

Role Description

The VA Northeast Ohio Healthcare System is recruiting for a Medical Records Technician (Coder-Outpatient) position. The Medical Records Technician (Coder-Outpatient) is located in the Health Information Management Services (HIMs) section within Patient Care Administrative Service.

• Assigns codes to the most basic and routine outpatient services and/or inpatient admissions; develops skill and knowledge of health record coding.
• Has basic knowledge of medical terminology, anatomy & physiology, and diseases.
• Selects and assigns codes from the current versions of the International Classification of Diseases (ICD), Current Procedural Terminology (CPT), and/or Healthcare Common Procedure Coding System (HCPCS).
• Learns to select diagnosis, operation, or procedure codes based on accepted coding practices, guidelines, conventions, and policy.
• Reviews record documentation to abstract all required medical, surgical, ancillary, demographic, social, and administrative data with guidance and instruction from supervisor or senior coder.
• Utilizes the facility computer system and software applications to code, abstract, record, and transmit data to the national VA database in Austin.
• Identifies data errors reviewed with a senior coder or the supervisor and corrections made as directed.
• Uses a variety of window-based applications in day-to-day activities and duties, such as Outlook, Excel, Word, and Access.
• Develops use of the health record applications (VistA and CPRS) as well as the encoder product suite.
• Ensures current versions of all software applications are loaded and functional after any updates or changes.
• Maintains current knowledge of regulatory and policy requirements affecting coded information.
• Reviews health record documentation to abstract all required medical, surgical, ancillary, demographic, social, and administrative data.
• Uses knowledge of the organization and structure of the patient health record to capture and justify code assignment.
• Corrects any identified data errors or inconsistencies in a timely manner to ensure acceptance in the national VA database within established timelines.
• Provides support in the areas of regulations and policy, coding requirements, resident supervision, reimbursement, accepted nomenclature, and proper sequencing.
• Works within a team environment; supports peers in meeting goals and deadlines; flexible and handles multiple tasks; works under pressure; and copes with frequently changing projects and deadlines.

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.
• United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy.
• English Language Proficiency: MRTs (Coder) must be proficient in spoken and written English as required by 38 U.S.C. § 7403(f).
• Experience: One year of creditable experience that indicates knowledge of medical terminology, anatomy, physiology, pathophysiology, medical coding, and the structure and format of health records.
• Education: An associate's degree from an accredited college or university recognized by the U.S. Department 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.
• 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 coding.
• Equivalent combinations of creditable experience and education are qualifying for meeting the basic requirements.

Requirements

• Persons hired or reassigned to MRT (Coder) positions in the GS-0675 series in VHA must possess one of the following certifications:
• Apprentice/Associate Level Certification through AHIMA or AAPC.
• Mastery Level Certification through AHIMA or AAPC.
• Clinical Documentation Improvement Certification through AHIMA or ACDIS.
• May qualify based on being covered by the Grandfathering Provision as described in the VA Qualification Standard for this occupation.

Benefits

• Relocation/Recruitment Incentives: Not Authorized
• Permanent Change of Station (PCS): Not Authorized

Work Schedule

• Monday - Friday, 8:00am - 4:30pm

Remote

• This position is designated as remote. Remote work is defined as full-time employment conducted outside of a VA facility or in VA-leased spaces.
• The option for remote work will be assessed continuously, and the selected individual may need to return to a VA office if required.
• Applicants must live within 50 miles of one of our facilities as they may be subject to the RTO order.

Virtual

• This is not a virtual position.

Functional Statement #

• 91764A, 91765A, 91766A, 91767A, 91768A

Education Requirements

• A transcript must be submitted with your application if you are basing all or part of your qualifications on education.
• Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment.
• 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 education.

Grade Determinations

• GS-4: None beyond basic requirements.
• GS-5: One year of creditable experience equivalent to the next lower grade level; OR successful completion of a bachelor's degree from an accredited college or university recognized by the U.S. Department of Education.
• GS-6: One year of creditable experience equivalent to the next lower grade level.
• GS-7: One year of creditable experience equivalent to the next lower grade level.
• GS-8: One year of creditable experience equivalent to the next lower grade level.