Description:
Perform post-payment review for Diagnosis Related Group (DRG) validation on inpatient medical records using International Classification of Diseases, Tenth Revision (ICD-10-CM) and Procedural Coding System (ICD-10-PCS) to identify incorrect coding.
Responsibilities:
- Review and analyze inpatient hospital medical records using International Classification of Diseases, Tenth Revision (ICD-10-CM) and Procedural Coding System (ICD-10-PCS) and always coding to the highest level of specificity
- Follow the Official ICD-10-CM Guidelines for Coding and Reporting and the ICD-10-PCS Official Guidelines for Coding and Reporting and have a complete understanding of these guidelines
- Ability to meet productivity and accuracy standards
- Ability to defend coding decisions to both internal and external audits
- Ability to calculate payment based on provider contracts
- Identify coding error (e.g., incorrect primary diagnosis, MCCs, CCs, and procedure codes) and recommend correct coding of medical claims
- Receive, research, and determine appropriate coding for provider denial appeals from Correspondence, PRT, Claims, and the Markets
- Support claims, configuration, PRT, and/or appeal and grievances teams as necessary
- Perform other duties as assigned
Education Level Education:
- A High School diploma or GED required
Work Experience Experience:
- 2+ years of experience in professional coding experience either in a hospital or physician setting – required
- Healthcare industry experience preferred
Licenses/Certifications:
- Certified Coding Specialist (CCS) required
- Certified Inpatient Coder – Hospital (CIC) preferred
Skill Sets:
- Demonstrated interpersonal/verbal communication skills
- Demonstrated written communication skills
- Ability to work as part of a team
- Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
- Advanced ability to work independently
- Working knowledge of CMS Official Guidelines for coding and reporting
- Microsoft Outlook
- Microsoft Excel
- Microsoft Word
- Healthcare Management Systems (Generic)
- Other strong knowledge of medical terminology and abbreviations
- Other working knowledge of MUEs, LCDs, and other coding resources from CMS