Livanta is expanding its Medicare QIO operations! Multiple full and part time openings available!

Searching for qualified senior coding specialist (SCSs) with experience validating assignments of Medicare Severity Diagnosis Related Groups (MS-DRGs) that are used by Medicare Administrative Contractors (MACs) to calculate pricing for Medicare inpatient hospital claims. In-depth understanding of the Medicare prospective payment system is required. The ideal SCS will have an expert level of competency with (1) coding and sequencing diagnoses and procedures using the ICD-10-CM and ICD-10-PCS systems for appropriate MS-DRG assignment; (2) abstracting, interpreting, and validating the reporting by hospitals of other inpatient variables that can affect Medicare payment models; (3) reviewing and interpreting proper sources of clinical documentation to support coding and querying decisions; (4) performing inpatient coding audits or reviews; (5) recording clear and concise rationales for review decisions citing appropriate references as applicable, (6) communicating both orally and in writing in clear English utilizing proper grammar, punctuation, spelling, and syntax; (7) interacting with physicians to obtain pertinent medical input that might impact coding decisions; (8) ensuring both auditor and physician rationales are precise and complete; (9) elevating questions for supervisory guidance and resolution; (10) using industry tools (e.g., 3M encoder/grouper, AHA Coding Clinic, etc.) and other information systems; and (11) performing other related activities with independence and professionalism. The SCS will interact with educators, quality assurance personnel, outreach and training personnel, and other staff on a routine basis to deliver a quality, reliable product.

In addition to pertinent and practical background and experience performing MS-DRG reviews or audits, the SCS must have an appropriate AHIMA credential to perform inpatient coding audits such as RHIA, RHIT, or CCS; evidence of maintaining continuing education credits to ensure credentials are maintained in an active status; and ability to pass all background and related employment screening. Experience performing higher-weighted DRG reviews for a Quality Improvement Organization or DRG reviews for a Medicare Recovery Audit Contractor preferred.