DRG Medical Coding Specialist

» DRG Medical Coding Specialist
Healthcare
in Phoenix
, AZ
Reference: 19-02760

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