[Hiring] Coder Reviewer @Commence

Role Description

The Coder Reviewer position is responsible for supporting and conducting reviews and determinations for independent dispute resolutions at both the Federal and State levels. This role requires expertise in clinical documentation review, clinical data abstraction, clinical coding, auditing, and variables impacting payment methodologies based on 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.

Qualifications

• 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.
• 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.

Requirements

• 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.

Benefits

• Schedules may vary and may include weekend and holiday shifts.
• 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.