Senior Coding Specialist
Commence, Las Vegas, NV, United States
Description
The Senior Coding Specialist independently reviews, accurately assigns, and abstracts diagnostic and procedural codes to encounters using designated coding classifications.
Job Type Full-time
Requirements At Commence, we’re the start of a new age of data‑centric transformation, elevating health outcomes and powering more efficient processes for 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 concept and performance beyond 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 HIPAA and HITECH.
Attends annual security awareness, rules of conduct, and conflict of interest training.
Performs other duties as assigned.
Essential Knowledge Advanced knowledge of ICD‑10 codes and the Diagnosis Related Group (DRG) classification system. Experience using industry tools such as Encoder, Grouper, and the American Hospital Association (AHA) Coding Clinic.
Essential Education Preference for personnel with current unrestricted credentials of RHIA, RHIT, or CCS. The license must be recognized in the jurisdiction(s) relevant to the work assigned. For a federal contract it 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 documentation. Must be able to apply all relevant ICD‑10 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 employee’s licenses or certifications, including, but not limited to, restrictions, state changes, revocations or expirations, or any disciplinary action 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 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.
EEO Statement 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.
Salary Description $70,000‑$85,000
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Job Type Full-time
Requirements At Commence, we’re the start of a new age of data‑centric transformation, elevating health outcomes and powering more efficient processes for 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 concept and performance beyond 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 HIPAA and HITECH.
Attends annual security awareness, rules of conduct, and conflict of interest training.
Performs other duties as assigned.
Essential Knowledge Advanced knowledge of ICD‑10 codes and the Diagnosis Related Group (DRG) classification system. Experience using industry tools such as Encoder, Grouper, and the American Hospital Association (AHA) Coding Clinic.
Essential Education Preference for personnel with current unrestricted credentials of RHIA, RHIT, or CCS. The license must be recognized in the jurisdiction(s) relevant to the work assigned. For a federal contract it 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 documentation. Must be able to apply all relevant ICD‑10 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 employee’s licenses or certifications, including, but not limited to, restrictions, state changes, revocations or expirations, or any disciplinary action 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 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.
EEO Statement 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.
Salary Description $70,000‑$85,000
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