Inpatient Coder

UHS•Richmond, VA

18h

About The Position

The Atlantic Region Central Billing Office (“ARCBO”) or (“CBO”) provides business office services including billing, collections, cash posting, pre-access management, variance, and customer service to our affiliated Universal Health Services hospitals. The Atlantic Region CBO is seeking a dynamic and talented Inpatient Coder for our Appeals department. The primary responsibility of the DRG Coder is to analyze third party coding audits of paid claims, draft detailed appeal letters, evaluate clinical level of care and review denial trends.

Requirements

High school diploma or equivalent
Professional coding certification (CCA, CCS, CCS-P, CPC, RHIT, RHIA (One required))
IP DRG experience
1-3 years coding experience
Strong Microsoft Office skills (Excel, Word, Outlook)
An understanding of anatomy, physiology, pharmacology, microbiology and medical terminology is required.

Nice To Haves

3-5 years (preferred) coding experience
Familiarity with appeals
1-3 years of healthcare business office experience preferred

Responsibilities

Perform DRG (Diagnosis Related Group) validation reviews in response to audits from third party payers.
Review audit findings letters from third party payers to obtain a clear understanding of audited diagnosis codes and underlying payer clinical / coding rationale.
Analyze medical records to obtain supporting clinical documentation for billed diagnosis codes.
Write detailed appeal letters based on clinical findings to third party payers to prevent downgrade payment recoveries.
Make decision to update DRGs or remote or add to billed diagnose codes based on clinical reviews
Assign DRG audits to nurse auditors when coding audit is based on clinical criteria.
Provide analysis and assistance as needed to the appeals department.
Assist customer service with patient complaints related to coding issues on their medical bills.
Provide a detailed charge/coding breakdown to assist with medical claims that need to be split billed based on various clinical scenarios.
Manage multiple spreadsheets including DRG inventory and inventory returned from vendors.
Maintain educational guidebooks for multiple department workflows.
Assist with drafting and maintaining appeal letter templates.
Identify audit trends and provide feedback to management and to UHS acute care facilities.
Adherence to all applicable laws, regulations and guidelines.
Other duties as assigned.