HSCRC Coding Reviewer
Remote · Virginia Beach, Virginia, United States
Job Summary
The HSCRC Coding Reviewer is a subject matter expert in clinical documentation review, clinical data abstraction, clinical coding, auditing, and variables impacting HSCRC payment methodologies. Performs compliance audits, data abstraction and collection activities, interprets and applies coverage and payment policies, edits, and regulatory requirements for medical necessity and other audit decisions; classifies findings and provides commentary for clinical data, qualitative, and statistical analyses; writes reports in accordance with company requirements; provides feedback to hospitals concerning audit findings and discusses rationales for audit decisions. Performs audit functions for the HSCRC Inpatient/Outpatient Data Abstract Review Contract; generates deliverables and audit work papers; requires outstanding verbal and written communication with hospital and client personnel; remote/work environment may be office/remote.
Required Qualifications
- Bachelor’s degree in a related discipline or specialized licensure, certification, or accreditation
- RHIA, RHIT, RN, or MD; CCS, CCS-P, CPC, CRC
- 5 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.
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