Senior Coding Specialist

The Senior Coding Specialist independently reviews, accurately assigns, and abstracts diagnostic and procedural codes to encounters using designated coding classifications.

At Commence, we’re the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient process to program and patient health. We combine quality data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care. 

With human-centered, healthcare-relevant, and value-based solutions, we create new possibilities with data. We provide proof beyond the concept and performance beyond the scope with a focus on efficiencies that transform the lives of those we serve. With a culture driven by purpose, straightforward communication and clinical domain expertise, Commence cuts straight to better care.  

Primary Duties:

• Performs validation of Higher-Weighted Diagnosis Related Groups (HWDRG) reviews.
• Adheres to and maintains required performance levels in both coding accuracy and productivity. 
• Reviews electronic and scanned medical records and compares codes submitted by hospitals to documentation. 
• Maintains concurrent entry in the case review information system for all cases selected for review. 
• Records clear and concise rationales for review decisions citing appropriate references as applicable. 
• Demonstrates clear written and oral communication skills utilizing proper grammar, punctuation, spelling, and syntax. 
• Interacts with physicians to obtain pertinent medical input that might impact coding decisions. 
• Ensures both coder and physician rationales are precise and complete. 
• Interacts with educators regarding potential hospital coding patterns. 
• Composes letters to providers explaining review details and recommends changes to the codes and HWDRGs submitted. 
• Protects the confidentiality of patient information through compliance with the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH). 
• Attends annual security awareness, rules of conduct, and conflict of interest training. 
• Performs other duties as assigned.

Essential Knowledge:

Advanced knowledge of International Classification of Diseases (ICD)-10 codes and Diagnosis Related Group (DRG) classification system. Experience using industry tools, such as Encoder, Grouper, and American Hospital Association (AHA) Coding Clinic.

Essential Education:

Preference for personnel with current unrestricted credentials of Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or Certified Coding Specialist (CCS). License must be recognized in the jurisdiction(s) relevant to the work assigned. For example, for a federal contract the license must be issued by a body within the United States.

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 HWDRG assignment. 

This position requires notifying a Commence 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 inpatient 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. 

Commence.AI is committed to providing equal employment opportunities to all applicants, including individuals with disabilities. If you require a reasonable accommodation to participate in the application process due to a disability, please contact Human Resources at (757) 306-4920 or hr@commence.ai. Please note that unless you are requesting accommodation, all applications must be submitted through our online application system.