IDR Coder Reviewer

Commence • Virginia Beach, VA

5d • $45 - $70 • Remote

About The Position

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.

Requirements

• 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.
• 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.

Nice To Haves

• 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.
• Established, professional relationships with internal personnel at all levels within the company and with beneficiaries, representatives, providers, and other stakeholders.

Responsibilities

• 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.

Benefits

• Equal employment opportunity employer
• Personnel processes are merit-based and applied without discrimination
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

What This Job Offers

• Job Type: Part-time
• Career Level: Senior