Medical Coder III

Join Decypher and make a direct impact on the health and readiness of Americas service members, veterans, and their families. Since 2008 Decypher has offered healthcare industry professionals careers where their expertise is valued, and their work makes a meaningful impact. Decypher partners with the Defense Health Agency to deliver professional services, technology, and management solutions. Our mission is to provide and support quality care for our veterans, servicemembers and their families, across the United States.

Job Summary: Medical Coder III utilizes advanced expertise in ICD-CM, ICD-PCS, CPT, HCPCS, reimbursement methodologies, and medical coding regulations to accurately support institutional and professional healthcare coding operations. Applies comprehensive knowledge of clinical documentation, healthcare compliance, revenue cycle management, EHR workflows, and coding audit principles to ensure accurate reimbursement, regulatory compliance, and continuous process improvement.

Required Qualifications:

Required Experience:

• Five (5) years of medical coding and/or auditing experience in two (2) or more medical, surgical, and ancillary specialties within the past 10 years; OR
• Three (3) years of medical coding or auditing experience if that experience was in an MTF.
• A minimum of one (1) year of performance in the specialty is required to be documented to be considered qualifying.

Education: Completion of ONE of the following:

• Associate's Degree or higher in

• Health Information,

• Healthcare Administration OR

• Biological Science

• University Certificate in medical coding

• At least 30 semester hours university/college credit that includes relevant coursework such as anatomy/physiology, medical terminology, health information management, or pharmacology

• Successful completion of American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) coding certification preparation course for professional services or facility coding that includes medical terminology, anatomy and physiology, health information management concepts, and pharmacology.

• Successful completion of a training course beyond apprentice level for medical technicians, hospital corpsmen, medical service specialists, or hospital training, obtained in a training program given by the Armed Forces or the U.S. Maritime Service under close medical and professional supervision

Certification: ONE of the following recognized professional coding certifications:

• Certified Professional Coder (CPC)

• Registered Health Information Technician (RHIT)

• Registered Health Information Administrator (RHIA)

• Certified Coding Specialist Physician (CCS-P)

AND ONE of the following recognized institutional coding certifications:

• Certified Inpatient Coder (CIC)

• Registered Health Information Administrator (RHIA)

• Registered Health Information Technician (RHIT)

• Certified Coding Specialist (CCS)

AND ONE of the following recognized E&M coding certifications:

• Certified Evaluation and Management Coder (CEMC)
• Certified Evaluation and Management Auditor (CEMA)
• National Alliance of Medical Auditing Specialist' (NAMAS)

Note: A Registered Health Information Technician (RHIT) and Registered Health Information Administrator (RHIA) from AHIMA may be counted towards either the professional services or institutional coding certification requirement, but not both unless the individual possesses the required institutional and professional services experience for the specific position sought.

Medical Coding Test: minimum 80% passing score

Key Responsibilities:

• Advanced knowledge of the International Classification of Diseases, Clinical Modification (ICD-CM), and Procedural Coding System (PCS); Healthcare Common Procedure Coding System (HCPCS); and Current Procedural Terminology (CPT), as used in institutional and professional services medical coding.
• Advanced knowledge of reimbursement systems, including Prospective Payment System (PPS) and Diagnostic Related Groupings (DRGs); Ambulatory Payment Classifications (APCs); and Resource-Based Relative Value Scale (RBRVS).
• Advanced knowledge and understanding of industry nomenclature; medical and procedural terminology; anatomy and physiology; pharmacology; and disease processes.
• Practical knowledge of medical specialties; medical diagnostic and therapeutic procedures; ancillary services (includes, but is not limited to: Laboratory, Dental, Occupational Therapy, Physical Therapy, and Radiology); and revenue cycle management concepts related to medical coding.
• Practical knowledge and understanding of Government rules and regulations regarding medical coding, reimbursement guidelines, and healthcare fraud; commercial reimbursement guidelines and policies; coding audit principles and concepts, and potential areas of risk for fraud and abuse. Includes, but not limited to: The Federal Register, Center for Medicare, and Medicaid Services (CMS) Local Coverage Determinations and National Coverage Determinations (LCD and NCD), National Correct Coding Initiative (NCCI) guidance, manual, and edits, Internet-Only Manuals (IOMs), and HHS-OIG publications and reports.
• Practical knowledge of clinical documentation improvement and continuous process improvement processes.
• Practical knowledge of EHR systems and workflows pertaining to medical coding.

U.S. Citizenship is required.

Work Environment and Schedule:

• 100% Remote
• Flexible scheduling SundaySaturday
• Up to 40 hours per week

Compensation and Benefits: Up to $40.09 per hour + H&W

Physical requirements: May be required to lift 20-25 pounds independently. Position requires long periods of sitting in an office setting.

We are currently hiring remote medical coders in:

AK,AL,AR,AZ,CA,CO,FL,GA,HI,IL,IN,KS,LA,MD,ME,MO,MS,NC,NE,NM,NV,OH,OK,SC,TN,TX,UT,VA,WA

Decypher is an equal opportunity and affirmative action employer committed to a diverse and inclusive workforce (M/F/D/V)