Coder Reviewer

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🔥 0 minutes ago

⚔️ Virginia – Remote

⚔️ Virginia – Remote

💵 $45 - $70 / hour

⏱ Part Time

🟢 Junior

🟡 Mid-level

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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

• Support and conduct reviews and determinations for independent dispute resolutions at Federal and State levels • Perform clinical documentation review, clinical data abstraction, clinical coding, auditing, and analysis of payment-methodology variables • Perform compliance audits using specified protocols and criteria • Conduct data abstraction and collection activities • Interpret and apply coverage and payment policies, edits, certification requirements, and regulatory requirements • Classify findings and provide commentary for clinical data, qualitative, and statistical analyses • Record the rationale and basis of audit findings • Write reports according to company requirements • Provide feedback to hospitals and discuss rationales for audit decisions • Perform audit functions for identified encounters accurately and on time • Generate written deliverables and audit work papers • Coordinate with physician reviewers responsible for clinical decisions

🎯 Requirements

• 2 or more years of relevant experience performing complex coding, quality assurance, training, appeals, and/or auditing services • Experience involving ICD-10-CM/PCS, CPT/HCPCS, DRG/APRDRG, and/or other healthcare coding, classification, or payment systems • Bachelor’s degree in a related discipline or specialized licensure, certification, or accreditation • RHIA, RHIT, RN, or MD; CCS, CCS-P, CPC, or CRC credentials listed • Proven track record of auditing clinical coding and supporting clinical documentation for RNs and other medical-degree personnel • Ability to apply relevant ICD-10 diagnosis and procedure coding guidelines for appropriate MS-DRG assignment • Senior-level outpatient hospital coding experience • Ability to research, determine, and apply solutions • Effective communication with reviewers and clients • Knowledge of and ability to comply with HIPAA and other confidentiality, privacy, and protected-health-information regulations • Knowledge of and ability to comply with system and information-security requirements • Ability to write plain-language summaries of medical facts and coding principles with authoritative references • Ability to coordinate work and communicate with physician reviewers • Ability to work varying schedules, including possible weekend and holiday shifts • Must notify a Livanta HR Manager within five calendar days of status changes or disciplinary proceedings involving licenses or certifications