IDR Coder Reviewer (Healthcare)

TL;DR

IDR Coder Reviewer (Healthcare): Conducting reviews and determinations for independent dispute resolutions at Federal and State levels with an accent on clinical documentation review and payment methodologies. Focus on performing compliance audits, interpreting coverage policies, and providing evidence-based rationales for audit findings.

Location: Remote (USA)

Salary: $45–$70 per hour

Company

A data-centric healthcare company focusing on elevating health outcomes through quality data-driven solutions and clinical expertise.

What you will do

• Conduct reviews and determinations for independent dispute resolutions at Federal and State levels.
• Perform compliance audits and clinical data abstraction using specified protocols.
• Interpret coverage and payment policies to make medical necessity and audit decisions.
• Write detailed reports and professional rationales for audit findings.
• Provide feedback and discuss audit results with hospitals and clients.

Requirements

• Must be based in the USA to comply with HIPAA and US healthcare regulations.
• 2+ years of experience in complex coding involving ICD-10-CM/PCS, CPT/HCPCS, and DRG/APRDRG.
• Senior-level outpatient hospital coding experience.
• Bachelor’s degree in a related field or certifications such as RHIA, RHIT, RN, MD, CCS, CPC, or CRC.
• Proven track record of auditing clinical coding and supporting clinical documentation.
• Practical knowledge of HIPAA and information security requirements.

Culture & Benefits

• Fully remote work arrangement.
• Healthcare benefits provided.
• Purpose-driven culture with a focus on straightforward communication.
• Opportunity to work in a data-centric transformation environment.