Certified Medical Coder, Medicare

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🔥 0 minutes ago

⚔️ Virginia – Remote

⚔️ Virginia – Remote

💵 $58k - $78k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🏥 Medical Billing and Coding

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LivantaLLC

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2004

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

Livanta LLC is a technology-enabled organization dedicated to advancing healthcare quality through innovation. It specializes in providing services to patients, caregivers, healthcare providers, and payers, focusing on improving health outcomes, navigating healthcare systems, and ensuring payment accuracy. Livanta is recognized as the largest Medicare Quality Improvement Organization and offers a range of services including quality oversight, auditing, advocacy, and data analytics to enhance patient care and safety while managing healthcare costs effectively.

📋 Description

• Perform coding-only medical reviews, with no clinical judgment required, on Medicare Part A/B and DMEPOS claims • Apply ICD-10-CM/PCS, CPT/HCPCS, and DRG/APR-DRG coding rules • Research and apply NCDs, LCDs, and CMS coding/payment guidance • Render and document coding determinations • Identify potential improper payments, coding errors, and documentation patterns indicative of fraud, waste, or abuse for referral consideration • Maintain claim review documentation in the designated case tracking system • Support claim re-review and provider education sessions as requested • Maintain individual accuracy score according to company standards • Complete required annual trainings, including ethics, records management, and security controls • Maintain HIPAA/PHI compliance

🎯 Requirements

• 3+ years of direct experience in medical coding, medical billing, and/or coding quality assurance/auditing in a healthcare environment • Experience with ICD-10-CM/PCS, CPT/HCPCS, and DRG/APR-DRG coding systems • Active coding certification through AAPC or AHIMA: CPC, CCS, CCS-P, CRC, RHIA, or RHIT • Ability to research, apply, and document coding determinations according to CMS coverage, coding, and payment rules, including NCDs/LCDs • Ability to work independently and productively in a remote, technology-driven, queue-based claims review environment • Working knowledge of HIPAA and other laws/regulations governing confidentiality and privacy of PHI and PII • Working knowledge of CMS system and information security requirements • Associate's degree in a related discipline, or equivalent combination of certification and relevant experience in lieu of a degree • 3+ years of Medicare Fee-for-Service (FFS) claim review experience preferred • Experience with queue-based or low-code/no-code case management systems preferred • Prior experience on a CMS program integrity, audit, or medical review contract preferred

🏖️ Benefits

• Remote position • Reasonable accommodations for individuals with disabilities • Equal employment opportunity