IDR Coder Reviewer

Coding Specialist (Part-Time)

At Commence, we're the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient processes to program and patient health. We combine quality data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care.

With human-centered, healthcare-relevant, and value-based solutions, we create new possibilities with data. We provide proof beyond the concept and performance beyond the scope with a focus on efficiencies that transform the lives of those we serve. With a culture driven by purpose, straightforward communication and clinical domain expertise, Commence cuts straight to better care.

The Coder Reviewer position is responsible for supporting and conducting reviews and determinations for independent dispute resolutions at both the Federal and State levels. Subject matter expert in clinical documentation review, clinical data abstraction, clinical coding, auditing, and variables impacting payment methodologies that are based in medical record documentation. Performs compliance audits employing specified protocols and criteria; conducts data abstraction and collection activities; interprets and applies coverage and payment policies, edits, and certification and regulatory requirements for medical necessity and other audit decisions; classifies findings and provides commentary for clinical data, qualitative, and statistical analyses; records rationale for and basis of audit findings using proper grammar and communication methods; writes reports in accordance with company requirements. Provides feedback to hospitals concerning audit findings and discusses rationales for audit decisions.

Primary Duties:

• Performing audit functions for the identified encounters in a timely and accurate manner.
• Generating well-written deliverables and audit work papers.
• Outstanding verbal communication skills.
• Outstanding communications and interactions with hospital and client personnel.

Requirements:

Essential Knowledge:

• 2 or more years of relevant experience performing complex coding; quality assurance, training, appeals, and/or auditing services involving ICD-10-CM/PCS, CPT/HCPCS, DRG/APRDRG, and/or other coding, classification, and/or payment systems pertinent in the healthcare industry, including but not limited to, State of Maryland, in particular.
• Ability to research, determine, and apply solutions.
• Ability to communicate effectively with other reviewers and clients to ensure quality of audit findings and acceptance and understanding of findings.
• Practical knowledge of and ability to comply with Health Insurance Portability and Accountability Act (HIPAA), and other laws and regulations pertaining to confidentiality, privacy of protected health information, personally identifiable information, and other sensitive information.
• Practical knowledge of and ability to comply with system and information security requirements.

Essential Education:

• Bachelor's degree in a related discipline or specialized licensure, certification, or accreditation.
• RHIA, RHIT, RN, or MD; CCS, CCS-P, CPC, CRC
• Registered Nurses (RNs) and other personnel with medical degrees will be considered if they have a proven track record of auditing clinical coding and supporting clinical documentation. Must be able to apply all relevant ICD-10 diagnosis and procedure coding guidelines for appropriate MS-DRG assignment.

This position requires notifying a Livanta HR Manager in writing within five calendar days if there is any status change or disciplinary proceeding relating to any of Employee's licenses or certifications, including, but not limited to, (1) restrictions on an employee's license or certification, (2) changes to the states in which Employee can practice (3) revocation or expiration of any license or certification, and (4) any potential or actual disciplinary action against Employee by a certifying or licensing body.

Essential Skills:

• Must have senior-level outpatient hospital coding experience. Must write in plain language, summarizing medical facts and coding principles that support coding decisions, including appropriate references from authoritative sources. Must be able to coordinate work and communicate efficiently with physician reviewers responsible for making clinical decisions.

Organizational "Fit" Considerations:

• Schedules may vary and may include weekend and holiday shifts. This position requires established, professional relationships with internal personnel at all levels within the company and with beneficiaries, representatives, providers, and other stakeholders.

Work Environment/Physical Demands:

• The work environment and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• This is an office/remote position. While performing the duties of this job, the employee regularly works in a climate-controlled environment. Candidates must be able to sit, read, work on a computer, and watch a computer screen for extended periods of time. Occasionally required to stand, walk, use hands and fingers, kneel or crouch.

Commence is an equal employment opportunity employer. All personnel processes are merit-based and applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military and veteran status or any other characteristic protected by applicable law.

Commence.AI is committed to providing equal employment opportunities to all applicants, including individuals with disabilities. If you require a reasonable accommodation to participate in the application process due to a disability, please contact Human Resources at (757) 306-4920 or hr@commence.ai.