Virginia Beach, Virginia, United States · Remote Solely
$58k–$78k/yr
Mid level
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Skills: Medical Coding, Medicare Part A/B, DMEPOS, ICD-10-CM, CPT
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Virginia Beach, Virginia, United States · Remote Solely
Entry level
Join us as a Patient Billing Specialist, where you’ll support patients with payment processing, billing education, insurance verification, and claims-related inquiries. This role delivers empathetic, accurate, and compli…
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$58k–$78k/yr
Full-time
associate degree, professional certificate
Posted 24d ago
~40 hrs/week
Remote in Virginia, United States
Responsibilities
Perform coding-focused medical reviews on Medicare Part A/B and DMEPOS claims to ensure accuracy and medical necessity. Research and apply CMS coding guidelines while identifying potential improper payments or documentation patterns indicative of fraud.
Requirements
Requires 3+ years of direct experience in medical coding or auditing and an active coding certification from AAPC or AHIMA. Candidates must possess strong knowledge of CMS policies and the ability to work independently in a remote, queue-based environment.
Full job description
Description
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.?
Requirements
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 claim. They compare paid claim information against the provider's 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
Associate's 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.
Commence.AI 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 (757) 306-4920 or [email protected].Please note that unless you are requesting an accommodation, all applications must be submitted through our online application system.
Related keywords
Medical CodingMedicarePart A/BDMEPOSICD-10-CMCPTHCPCSDRGAPR-DRGCMSNCDLCDHIPAAPHIPIIAAPC
Commence Health is the BFCC-QIO for CMS Regions 2, 3, 5, 7 and 9
Industry
Hospitals and Health Care
Company size
201-500 employees
LinkedIn followers
111
Commence Health is the BFCC-QIO for CMS Regions 2, 3, 5, 7 and 9—supporting Medicare beneficiaries with appeals, complaints, and advocacy across 27 states and territories. As a program of Commence (formerly Livanta), we’re here to help patients and families navigate care with clarity, compassion, and confidence.