Fidelity Partners Services

General

• Remotely code and validate physician and other professional services for VISN 7
• Review inpatient and outpatient professional-service documentation
• Identify reportable diagnoses, procedures, services, and provider data
• Assign ICD-10-CM, CPT, and HCPCS Level II codes for professional-fee encounters
• Select and sequence evaluation and management codes using current guidelines and documentation requirements
• Apply Correct Coding Initiative bundling rules and appropriate modifiers
• Determine whether documentation supports billable services
• Identify unsupported, duplicate, incomplete, or incorrectly created encounters
• Abstract required data and enter or validate information in CPRS, VistA, approved encoder systems, and authorized VA applications
• Verify provider information and scope of practice
• Re-review coded encounters during pre-bill review or following denials; make corrections or provide coding justification
• Communicate documentation deficiencies, coding questions, and workflow concerns
• Protect VA information and follow privacy, information-security, encryption, and remote-work requirements
• Complete orientation, annual training, quality reviews, and corrective education
• Maintain required credentials, access approvals, and professional coding knowledge

Professional Fee Coder

• Review ambulatory surgery records and assign accurate ICD-10-CM, CPT, HCPCS, and modifier information
• Code surgical procedures and related anesthesia, pathology, diagnostic, and professional services as assigned
• Validate operative documentation, medical necessity, bundling edits, and code sequencing
• Submit compliant provider queries when operative or supporting documentation requires clarification
• Correct coding edits, rejections, audit findings, and identified documentation deficiencies
• Meet contract standards for accuracy, productivity, timeliness, and data integrity
• Use Oracle Health, Solventum CRS, CPRS, VistA, VIRR, and other authorized VA systems as required
• Protect patient information and comply with HIPAA, the Privacy Act, VA security requirements, and applicable coding standards

Ambulatory Surgery MRT Coder

Medical Billing and Coding

• Remotely review VA health records and accurately code inpatient episodes and outpatient encounters for VISN 7
• Identify reportable diagnoses, procedures, services, conditions, and required data elements
• Assign and sequence ICD-10-CM, ICD-10-PCS, CPT, and HCPCS Level II codes according to official guidelines and VA requirements
• Code outpatient clinic, urgent-care, radiology, laboratory, ancillary, and ambulatory surgical services as assigned
• Code inpatient episodes, including principal and secondary diagnoses, procedures, present-on-admission indicators, and DRG-related information
• Complete Patient Treatment File transition types and follow facility protocols for opening, correcting, and retransmitting inpatient records
• Apply Coding Clinic direction, CPT instructions, Correct Coding Initiative bundling rules, modifiers, and facility-specific protocols
• Review documentation for missing, conflicting, incomplete, duplicate, erroneous, or insufficiently supported information
• Abstract and enter or validate data in CPRS, VistA, approved encoder systems, and other authorized VA applications
• Re-review coded encounters during pre-bill review or after denials; make corrections or provide coding justification
• Maintain at least 95 percent coding accuracy and meet facility turnaround and delivery requirements
• Communicate documentation deficiencies, coding questions, and workflow concerns through established channels
• Protect VA information and complete required privacy, security, training, quality-review, and corrective-education activities

Inpatient/Outpatient Coder

Auditor

• Independently audit inpatient and outpatient facility coding for accuracy, documentation support, compliance, and reimbursement impact
• Evaluate ICD-10-CM, ICD-10-PCS, CPT, HCPCS Level II, evaluation and management, modifier, bundling, present-on-admission, procedure, and DRG assignments
• Review inpatient hospitalizations and outpatient clinic, urgent-care, radiology, laboratory, ancillary, observation, and ambulatory surgical encounters
• Assess diagnoses, procedure coding, documentation sufficiency, billability, and coding guidance
• Identify incorrect, missing, duplicate, unbundled, unsupported, upcoded, downcoded, or noncompliant codes, modifiers, and data elements
• Review electronic health record documentation and approved audit tools using established sampling requirements
• Document findings with supporting authority, financial impact, risk, and recommended corrective action
• Maintain audit accuracy of at least 95 percent and participate in calibration processes
• Contribute to audit work plans, collection tools, facility reports, consolidated reports, and progress updates
• Review preliminary findings with HIMS leadership, the COR, management, and facility personnel
• Prepare or support final reports on accuracy, documentation issues, financial impact, process improvement, and educational needs
• Develop and deliver facility-specific coding education, support exit conferences, and explain findings using authoritative guidance
• Protect VA information and meet audit schedules, reporting deadlines, training, credential, and access requirements

Inpatient/Outpatient Coding Auditor

• Review and code inpatient records, discharges, and related professional and surgical services for the VA Northeast Ohio Healthcare System
• Assign and validate diagnosis and procedure codes
• Abstract diagnoses, procedures, present-on-admission indicators, and other required data elements
• Submit compliant provider queries when documentation is incomplete, conflicting, or insufficient
• Code related professional, surgical, and ancillary services using CPT, HCPCS, and E/M requirements
• Correct coding edits, rejections, audit findings, and identified documentation issues
• Meet contract standards for coding accuracy, productivity, timeliness, and data integrity
• Use Oracle Health, Solventum CRS, CPRS, VistA, VIRR, and other authorized VA systems
• Protect patient information and comply with HIPAA, the Privacy Act, VA security requirements, and applicable coding standards

Inpatient Facility Coder

• Code and validate outpatient professional encounters across VA clinical specialties
• Assign ICD-10-CM, CPT, HCPCS, modifiers, and E/M levels
• Review documentation, medical necessity, code sequencing, and specialty-specific coding requirements
• Code clinic, emergency, diagnostic, procedural, and other assigned professional encounters
• Submit compliant provider queries and resolve incomplete or conflicting documentation
• Correct claim edits, coding rejections, audit findings, and identified data-quality issues
• Meet contract standards for accuracy, productivity, timeliness, and data integrity
• Use Oracle Health, Solventum CRS, CPRS, VistA, VIRR, and other authorized VA systems as required
• Protect patient information and comply with HIPAA, the Privacy Act, VA security requirements, and applicable coding standards

Outpatient Professional Coder

• Independently audit surgical and procedural coding for accuracy, documentation support, compliance, and reimbursement impact
• Evaluate ICD-10-CM, CPT, HCPCS Level II, modifier, global-package, and Correct Coding Initiative bundling assignments
• Identify incorrect, missing, unbundled, upcoded, downcoded, unsupported, or otherwise noncompliant codes and modifiers
• Review diagnoses and procedures in the electronic health record and approved audit tools using established sampling requirements
• Document findings with supporting authority, financial impact, risk, and recommended corrective action
• Maintain audit accuracy of at least 95 percent and participate in calibration processes
• Contribute to audit work plans, collection tools, facility reports, consolidated reports, and progress updates
• Review preliminary findings with HIMS leadership, the COR, management, and designated facility personnel
• Prepare or support final reports on accuracy, documentation issues, financial impact, process improvement, and educational needs
• Develop and deliver facility-specific coding education using actual findings and a train-the-trainer approach when assigned
• Support exit conferences and explain coding findings, recommendations, and authoritative guidance
• Protect VA information and follow privacy, information-security, encryption, and remote-work requirements
• Meet assigned audit schedules, reporting deadlines, training requirements, credential requirements, and access requirements

Surgery Coding Auditor

• Independently audit inpatient and outpatient professional-fee coding for accuracy, documentation support, compliance, and reimbursement impact
• Evaluate ICD-10-CM, CPT, HCPCS Level II, evaluation and management, modifier, professional-component, and bundling assignments
• Verify provider information, scope of practice, billability, and documentation support for reported professional services
• Identify incorrect, missing, unbundled, upcoded, downcoded, unsupported, or otherwise noncompliant codes and modifiers
• Review diagnoses and procedures in the electronic health record and approved audit tools using established sampling requirements
• Document findings with supporting authority, financial impact, risk, and recommended corrective action
• Maintain audit accuracy of at least 95 percent and participate in calibration processes
• Contribute to audit work plans, collection tools, facility reports, consolidated reports, and progress updates
• Review preliminary findings with HIMS leadership, the COR, management, and designated facility personnel
• Prepare or support final reports addressing accuracy, documentation issues, financial impact, process improvement, and educational needs
• Develop and deliver facility-specific coding education and support exit conferences
• Protect VA information and follow privacy, information-security, encryption, and remote-work requirements
• Meet assigned audit schedules, reporting deadlines, training requirements, credential requirements, and access requirements