IDR Coder Reviewer

About the role

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.

Responsibilities

• Support and conduct reviews and determinations for independent dispute resolutions at both the Federal and State levels.
• Serve as a subject matter expert in clinical documentation review, clinical data abstraction, clinical coding, auditing, and variables impacting payment methodologies based on medical record documentation.
• Perform compliance audits employing specified protocols and criteria; conduct data abstraction and collection activities.
• Interpret and apply coverage and payment policies, edits, and certification and regulatory requirements for medical necessity and other audit decisions.
• Classify findings and provide commentary for clinical data, qualitative, and statistical analyses.
• Record rationale for and basis of audit findings using proper grammar and communication methods; write reports in accordance with company requirements.
• Provide feedback to hospitals concerning audit findings and discuss rationales for audit decisions.
• Perform audit functions for identified encounters in a timely and accurate manner.
• Generate well-written deliverables and audit work papers.
• Demonstrate outstanding verbal communication skills and interactions with hospital and client personnel.
• Notify a Livanta HR Manager in writing within five calendar days of any status change or disciplinary proceeding relating to licenses or certifications, including restrictions, changes in practice states, revocation, expiration, or disciplinary action.

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/APR-DRG, and/or other coding, classification, and/or payment systems pertinent in the healthcare industry, including but not limited to, State of Maryland.
• 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).
• Certifications such as CCS, CCS-P, CPC, or 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.

Essential Skills

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

Additional 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.

Pay

$45–$70 per hour