At Commence, the company focuses on data-centric transformation in healthcare, combining quality data-driven solutions, technology, and clinical expertise to improve care outcomes and operational efficiency.
This role supports independent dispute resolution reviews and determinations at both the federal and state levels. The position involves clinical documentation review, clinical data abstraction, clinical coding, auditing, and evaluation of payment methodologies based on medical record documentation. The reviewer performs compliance audits using specified protocols and criteria, applies coverage and payment policies, and prepares written findings and reports. The role also includes communicating audit results and rationales to hospitals and other stakeholders.
Primary duties include performing audit functions for identified encounters in a timely and accurate manner, generating well-written deliverables and audit work papers, and maintaining clear verbal communication with hospital and client personnel.
This is an office/remote position and requires regular computer-based work in a climate-controlled environment.
Qualifications
- 2+ years of relevant experience in complex coding, quality assurance, training, appeals, and/or auditing services involving ICD-10-CM/PCS, CPT/HCPCS, DRG/APRDRG, or similar healthcare coding and payment systems.
- Senior-level outpatient hospital coding experience.
- Ability to research, determine, and apply appropriate solutions.
- Strong communication skills for working with other reviewers, clients, hospital personnel, and physician reviewers.
- Practical knowledge of HIPAA and other laws and regulations related to confidentiality, privacy, and protected health information.
- Practical knowledge of system and information security requirements.
- Bachelor’s degree in a related field or specialized licensure, certification, or accreditation.
- RHIA, RHIT, RN, MD, CCS, CCS-P, CPC, or CRC preferred/required as applicable.
- Ability to apply ICD-10 diagnosis and procedure coding guidelines for appropriate MS-DRG assignment.
- Ability to write in plain language and summarize medical facts and coding principles with authoritative references.
- Ability to coordinate work and communicate effectively with physician reviewers.
- Must be able to work varied schedules, including weekends and holidays.
Location
Virginia Beach, Virginia, US
Employment Type
Part-time
Experience Level
Senior
Remote work allowed
Yes
Posted
2 weeks ago