Coder Reviewer

This is a fully remote position, open to applicants in Virginia.

📋 Description

• Assist in conducting reviews and making determinations for independent dispute resolutions at both Federal and State levels.

• Carry out clinical documentation reviews, data abstraction, clinical coding, auditing, and analysis of payment methodology variables.

• Execute compliance audits following established protocols and criteria.

• Engage in data abstraction and collection processes.

• Interpret and implement coverage and payment policies, edits, certification requirements, and regulatory mandates.

• Classify observations and provide commentary for clinical data, qualitative assessments, and statistical analyses.

• Document the rationale and foundation of audit findings.

• Prepare reports in accordance with company specifications.

• Offer feedback to hospitals and discuss the reasoning behind audit decisions.

• Carry out audit tasks for identified encounters promptly and accurately.

• Produce written deliverables and audit documentation.

• Collaborate with physician reviewers responsible for clinical assessments.

⛳️ Requirements

• A minimum of 2 years of relevant experience in complex coding, quality assurance, training, appeals, and/or auditing services.

• Experience with ICD-10-CM/PCS, CPT/HCPCS, DRG/APRDRG, and/or other healthcare coding, classification, or payment systems.

• Bachelor’s degree in a related field or equivalent specialized licensure, certification, or accreditation.

• Credentials such as RHIA, RHIT, RN, or MD; CCS, CCS-P, CPC, or CRC are preferred.

• Demonstrated success in auditing clinical coding and supporting clinical documentation for RNs and other medically qualified personnel.

• Proficient in applying relevant ICD-10 diagnosis and procedure coding guidelines for accurate MS-DRG assignment.

• Senior-level experience in outpatient hospital coding.

• Capability to research, identify, and implement solutions.

• Strong communication skills with reviewers and clients.

• Understanding of and adherence to HIPAA and other confidentiality, privacy, and protected health information regulations.

• Familiarity with and compliance to system and information security requirements.

• Ability to write clear, plain-language summaries of medical facts and coding principles with reliable references.

• Proficient in coordinating tasks and communicating with physician reviewers.

• Willingness to work flexible schedules, including potential weekend and holiday shifts.

• Must inform a Livanta HR Manager within five calendar days of any changes in status or disciplinary actions related to licenses or certifications.

🏝️ Benefits

• Comprehensive health insurance plans.

• Generous paid time off and holiday schedule.

• Opportunities for professional development and continuing education.

• Retirement savings options with company matching contributions.