Certified Medical Coder (Medicare)

At Commence were 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.

The Certified Coder performs coding-focused medical review of Medicare Part A/B and DMEPOS claims for the program. Certified coders apply Medicare policies and guidelines ensuring claims are evaluated according to National and Local Coverage Determinations and CMS rules and document clear accurate findings for each compare paid claim information against the providers clinical documentation verifying the assigned ICD-10-CM CPT and HCPCS codes to confirm coding accuracy ensure medical necessity detect overpayments or underpayments and confirm compliance with Medicare policy.

• 3 years of direct experience in medical coding medical billing and/or coding quality assurance/auditing in a healthcare environment including ICD-10-CM/PCS CPT/HCPCS and DRG/APR-DRG coding systems
• Active coding certification through AAPC or AHIMA: CPC CCS CCS-P CRC RHIA or RHIT
• Ability to research apply and document coding determinations in accordance with CMS coverage coding and payment rules including National and Local Coverage Determinations (NCDs/LCDs)
• Ability to work independently and productively in a remote technology-driven queue-based claims review environment
• Working knowledge of and ability to comply with HIPAA and other laws/regulations governing confidentiality and privacy of protected health information (PHI) and personally identifiable information (PII)
• Working knowledge of and ability to comply with CMS system and information security requirements
• Associates degree in a related discipline or an equivalent combination of certification and relevant experience in lieu of a degree

Preferred Qualifications

• 3 years of Medicare Fee-for-Service (FFS) claim review experience
• Experience with queue-based or low-code/no-code case management systems as an end user
• Prior experience on a CMS program integrity audit or medical review contract (e.g. MAC RAC UPIC SMRC)

Key Responsibilities

• Perform coding-only medical reviews (no clinical judgment required) on Medicare Part A/B and DMEPOS claims applying ICD-10-CM/PCS CPT/HCPCS and DRG/APR-DRG coding rules
• Research and apply NCDs LCDs and CMS coding/payment guidance to render and document coding determinations
• Identify potential improper payments coding errors and documentation patterns indicative of fraud waste or abuse for referral consideration
• Maintain claim review documentation in the designated case tracking system
• Support claim(s) re-review and provider education sessions as requested
• Maintain individual accuracy score in accordance company standards
• Complete required annual trainings (e.g. ethics records management security controls) and maintain HIPAA/PHI compliance

Work Environment/Physical Demands

The work environment and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This is a remote position. While performing the duties of this job the employee regularly works in a climate-controlled environment. Candidates must be able to sit read work on a computer and watch a computer screen for extended periods of time. Occasionally required to stand walk use hands and fingers kneel or crouch.

Commence is an equal employment opportunity for employer. All personnel processes are merit-based and 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.

is committed to providing equal employment opportunities to all applicants including individuals with disabilities. If you require reasonable accommodation to participate in the application process due to a disability please contact Human Resources at or . Please note that unless you are requesting an accommodation all applications must be submitted through our online application system.