Qualifications

Basic Requirements:

• Citizenship
• United States Citizenship
• (Non-citizens may be appointed when it is not possible to recruit qualified citizens in accordance with chapter 3, section A, paragraph 3g.) Experience and Education: Must meet one of the following: (1) Experience
• One year of creditable experience that indicates knowledge of medical terminology, anatomy, physiology, pathophysiology, medical coding, and the structure and format of a health records
• OR, (2) 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 (e.g., courses in medical terminology, anatomy and physiology, medical coding, and introduction to health records)
• OR, (3) 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
• The 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.S. Department of Education accreditor, or comparable international accrediting authority at the time the program was completed
• OR, (4) Experience/Education Combination
• Equivalent combinations of creditable experience and education are qualifying for meeting the basic requirements
• The 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.S. Maritime 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 procedures
• Also, 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 the Supervisory 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
• NOTE: Mastery level certification is required for all positions above the journey level
• however, for clinical documentation improvement specialist assignments, a clinical documentation improvement certification may be substituted for a mastery level certification
• IN ADDITION TO MEETING THE BASIC REQUIREMENTS LISTED ABOVE, YOU MUST MEET THE SPECIALIZED EXPERIENCE AT THE GS-10 LEVEL TO QUALIFY FOR THIS POSITION
• GS-10 GRADE REQUIREMENTS: Experience: You must have one year of specialized experience equivalent to at least the next lower grade GS-9 in the normal line of progression for the occupation in the organization
• Examples of specialized experience would typically include, but are not limited to: Responsible for the supervision, administrative management, and direction of coding staff
• They are responsible for program management of a coding section/unit to ensure performance monitors are established and met
• They perform a full range of supervisory responsibilities, to include evaluating the performance of subordinate staff, approving sick and annual leave requests, identifying educational or training needs, resolving employee complaints, and taking disciplinary actions, when necessary
• They inform higher level management of anticipated vacancies or increases in workload
• They recommend employees for promotions, reassignments, recognitions, retention or release of probationary employees, or other changes of assigned personnel
• They make decisions on the selection of employees for vacant or new positions
• They serve as an expert coding resource to ensure accuracy and integrity of all coding
• They collaborate with revenue, compliance, and other departments to support coding accuracy that is consistent with the official guidelines for coding and reporting
• They resolve claim edits referred to coding management and monitor reports for outstanding services, rejects, or uncoded episodes of care for inpatients and/or outpatients
• The supervisory coder ensures claim denials related to coding errors are resolved, and/or daily coding rejects are corrected for accurate billing and data collection
• They provide education to clinical and coding staff
• They assess current audit findings and evaluate impact to coding and documentation practices
• The supervisory coder oversees the reporting of coding and documentation audit results to leadership
• They collect and prepare data for studies involving inpatient stays and outpatient encounters for clinical evaluation purposes, prepare and maintain a variety of complex records and daily, monthly, or "on demand" reports, as requested
• They create and monitor outpatient reports, inpatient case mix reports, top DRGs, and key performance indicators to identify patterns, trends, and variations, investigate and evaluate potential causes for changes or problems, and take appropriate steps, in collaboration with the appropriate staff, to effect resolution or explain variances
• They participate in the formulation of objectives and strategies using coded data to support goals for patient care, teaching, research, and optimizing management of resources
• Certification: Employees at this level must have a mastery level certification
• NOTE: See paragraph 2g for a detailed definition of mastery level certification
• AND Demonstrated Knowledge, Skills, and Abilities: In addition to the experience above, the candidate must demonstrate all of the following KSAs: Ability to perform a full range of supervisory duties, to include recommending awards, approving leave, evaluating work, resolving staff issues, and assigning, planning, and coordinating work to ensure duties are completed in an accurate and timely fashion
• Advanced knowledge of current coding classification systems such as ICD, CPT, and HCPCS for the subspecialty being assigned (outpatient, inpatient, outpatient and inpatient combined)
• Ability to provide or coordinate staff development and training
• Leadership and managerial skills, including skill in interpersonal relations and conflict resolution to deal with employees, team leaders, and managers
• Ability to collect and analyze data, identify trends, and present results in various formats
• Reference: For more information on this qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/.