Job Posting for Corporate Coding Auditor - DRG Denials at HIIM Coding

Community Health Systems is one of the nation’s leading healthcare providers. Developing and operating healthcare delivery systems in 43 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 77 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers.

SUMMARY:

As a remote member of the HIM Central Services coding DRG denials team, performs hospital inpatient DRG denial audits of RAC and non-RAC accounts. Reviews patient records for accuracy in ICD-10-CM/PCS, DRG assignment including review of supporting clinical documentation, present on admission indicators (POA), discharge disposition and any other pertinent data needed to capture coding accuracy. Writes and defends appeals letters payers with strong attention to detail. Provides audit feedback to pertinent parties including coders and coding managers.

Essential Duties and Responsibilities:

Performs inpatient denial reviews using ICD-10-CM/PCS and DRG validation utilizing appropriate coding references for CHS hospitals via scanned, electronic and hybrid medical records. Based on review findings, writes appeal letters to include supporting documentation.

Will utilize hospital abstracting system for coding validation when applicable with access to the 3M encoder.

Captures detailed data on reason for the denial and appeal status.

Consults with Coordinator and/or Director, Coding Denials and Appeals during any audit discrepancies.

Attends coding education to include regulatory change updates and changes affecting coding rules and/or DRG assignments

Maintains productivity levels set forth by the HIIM Department and interdepartmental policy with periodic quality monitoring and evaluation of work products by the Coordinator and/or Director, Coding Denials and Appeals.

Partners with peers and Director to develop coder education based on findings.

Qualifications:

Required Education:

High School Diploma or GED
ICD-10-CM, ICD-10-PCS & DRG Reimbursement

Preferred Education:

1 year coding certification, Associate or Bachelor’s degree in Health Information Management or related field
Extensive knowledge of clinical disease processes, medical terminology, pathophysiology, and pharmacology.

Required Experience:

3 years’ inpatient acute care hospital coding experience

Preferred Experience:

2 years inpatient acute care hospital auditing experience including writing of appeal letters
Experience in Clinical Documentation integrity

Required License/Registration/Certification: CCS, RHIA, or RHIT
Preferred License/Registration/Certification: CDIP

Computer Skills Required: Experience with virtual desktop image, electronic medical record systems, encoding systems as well as word processing and spreadsheet software

Physical Demands:
In order to successfully perform this job, with or without a reasonable accommodation, the following are outlined below:

The Employee is required to read, review, prepare and analyze written data and figures, using a PC or similar, and should possess visual acuity.

The Employee may be required to occasionally climb, push, stand, walk, reach, grasp, kneel, stoop, and/or perform repetitive motions.

The Employee is not substantially exposed to adverse environmental conditions and; therefore, job functions are typically performed under conditions such as those found within general office, home-based office or administrative work.

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Corporate Coding Auditor - DRG Denials

Job Posting for Corporate Coding Auditor - DRG Denials at HIIM Coding

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