What are the responsibilities and job description for the Coding Reviewer position at LivantaLLC?
Description
CODING REVIEWER
AND
CODING REVIEWER (PART-TIME)
(MEDICAL RECORD TECHNICIAN)
Summary/Objective
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.
Primary Duties
Essential Knowledge:
Bachelor’s degree in a related discipline or specialized licensure, certification, or accreditation.
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.
This position requires notifying a Livanta HR Manager in writing within five calendar days if there is any status change or disciplinary proceeding relating to any of Employee’s licenses or certifications, including, but not limited to, (1) restrictions on an employee’s license or certification, (2) changes to the states in which Employee can practice (3) revocation or expiration of any license or certification, and (4) any potential or actual disciplinary action against Employee by a certifying or licensing body.
Essential Skills
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.
Organizational "Fit" Considerations:
This position may require extended work hours during the week, weekends, holidays, and on-demand.
SENIOR CODING SPECIALIST (PART-TIME)
Additional Considerations
SCA Coverage:
Company is a federal contractor under the McNamara-O'Hara Service Contract Act (SCA).
The McNamara-O'Hara Service Contract Act (SCA) covers prime contracts of over $2,500 entered into by the federal government and the District of Columbia. The principal purpose of the contract is to furnish services in the U.S. through the use of service employees. The definition of "service employee" includes any employee engaged in performing services on a covered contract other than a bona fide executive, administrative, or professional employee who meets the exemption criteria outlined in 29 Code of Federal Regulations (CFR)
Wage Determinations and Employee Rights on Government Contracts are posted in break rooms (or an alternative location where labor law posters are displayed) for employees to review.
Livanta LLC is an equal employment opportunity employer. All personnel processes are applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military and veteran status or any other characteristic protected by applicable law.
If you need assistance or an accommodation due to a disability, you may contact us at 757-306-4920 or hr@livanta.com.
CODING REVIEWER
AND
CODING REVIEWER (PART-TIME)
(MEDICAL RECORD TECHNICIAN)
Summary/Objective
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.
Primary Duties
- 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.
Essential Knowledge:
- 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.
Bachelor’s degree in a related discipline or specialized licensure, certification, or accreditation.
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.
This position requires notifying a Livanta HR Manager in writing within five calendar days if there is any status change or disciplinary proceeding relating to any of Employee’s licenses or certifications, including, but not limited to, (1) restrictions on an employee’s license or certification, (2) changes to the states in which Employee can practice (3) revocation or expiration of any license or certification, and (4) any potential or actual disciplinary action against Employee by a certifying or licensing body.
Essential Skills
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.
Organizational "Fit" Considerations:
This position may require extended work hours during the week, weekends, holidays, and on-demand.
SENIOR CODING SPECIALIST (PART-TIME)
Additional Considerations
SCA Coverage:
Company is a federal contractor under the McNamara-O'Hara Service Contract Act (SCA).
The McNamara-O'Hara Service Contract Act (SCA) covers prime contracts of over $2,500 entered into by the federal government and the District of Columbia. The principal purpose of the contract is to furnish services in the U.S. through the use of service employees. The definition of "service employee" includes any employee engaged in performing services on a covered contract other than a bona fide executive, administrative, or professional employee who meets the exemption criteria outlined in 29 Code of Federal Regulations (CFR)
- 541. Under the SCA, covered employers must pay the prevailing wages and benefits in the locality—as determined by the U.S. Department of Labor (DOL) in a wage determination.
Wage Determinations and Employee Rights on Government Contracts are posted in break rooms (or an alternative location where labor law posters are displayed) for employees to review.
Livanta LLC is an equal employment opportunity employer. All personnel processes are applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military and veteran status or any other characteristic protected by applicable law.
If you need assistance or an accommodation due to a disability, you may contact us at 757-306-4920 or hr@livanta.com.
