HSCRC Coding Reviewer

About the role

The HSCRC Coding Reviewer will be a subject matter expert in clinical documentation review, clinical data abstraction, clinical coding, auditing, and variables impacting HSCRC payment methodologies that are based in medical record documentation.

Responsibilities

• Performs compliance audits employing specified protocols and criteria;
• Counsels and trains staff on coding and billing issues;
• 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.

Requirements

• 5 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.

Qualifications

• Bachelor’s degree in a related discipline or specialized licensure, certification, or accreditation. RHIA, RHIT, RN, or MD; CCS, CCS-P, CPC, CRC

Skills

• Outstanding verbal communication skills;
• Outstanding communications and interactions with hospital and client personnel.

Benefits

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. Please note that unless you are requesting an accommodation, all applications must be submitted through our online application system.

Pay

N/A

Schedule

N/A