Drg Coding Appeal Reviewer

Summary

Join MedReview, a leader in payment integrity solutions, as a DRG Appeal Reviewer. Under the direction of the DRG Operations Department, you will analyze provider responses on denied or downgraded MS-DRG and APR-DRG claims. Your responsibilities include reviewing inpatient claims, validating ICD-10-CM/PCS codes, constructing detailed response letters, and collaborating with physician reviewers. You will need coding certifications (RHIA, RHIT, CCS, or CIC), along with experience in MS-DRG and APR-DRG coding and appeals. Remote work is possible with a high-speed internet connection and a dedicated workspace. Excellent benefits are offered, including healthcare, 401(k) matching, generous PTO, wellness programs, and learning and development opportunities.

Requirements

• Coding Certification required (at least one of the following is required and must be maintained as a condition of employment). Registered Health Information Administrator (RHIA)
• Registered Heath Information Technician (RHIT)
• Certified Coding Specialist (CCS)
• Certified Inpatient Coder (CIC)
• College level courses in medical terminology, anatomy, pathophysiology, pharmacology, and medical coding courses
• 5+ years of experience in MS-DRG and APR-DRG coding experience through acute care inpatient coding, auditing, and/or payment integrity DRG Validation
• At least 2 years of appeal experience through the acute care setting and/or payment integrity DRG Validation
• Adherence to the Official Coding and Reporting guidelines, AHA Coding Clinic determinations, and CMS and other regulatory compliance guidelines and mandates
• Requires working knowledge of applicable industry-based standards
• Proficiency in Outlook, Word, Excel, and other applications
• Excellent written and verbal communication skills
• Maintain professional credentialed status with approved continuing education programs
• Ability to work independently and can multi-task or transition to different tasks easily
• High speed internet (100 Mbps per person recommended) with secured WIFI
• A dedicated workspace with minimal interruptions to protect PHI and HIPAA information
• Must be able to sit and use a computer keyboard for extended periods of time

Responsibilities

• Analyze and review inpatient claims following the Official Coding and Reporting Guidelines to validate the reported ICD-10-CM/PCS codes to ensure proper DRG assignment for accurate billing
• Demonstrates the ability to perform a comprehensive initial review as outlined in the standard operating procedures and departmental guides
• Construct professionally written and detailed responses to providers current coding and regulatory guidelines applicable to the downgraded claim
• Collaborates with physician reviewers, as needed
• Ability to prioritize and organize workload and complete tasks independently
• Required attendance of all departmental team meetings and/or training
• Work on other duties or tasks, as necessary
• Report productivity daily utilizing department productivity report
• Meet/exceed productivity expectations as outlined in the department productivity policy
• Maintains 95% accuracy in claim reviews
• Complies with organization policy and procedures

Preferred Qualifications

Other credential consideration: Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP) or Certified Professional Coder (CPC) will be considered but will need to obtain an inpatient coding certification (CCS or CIC) within 12 months of hire

Benefits

• Healthcare that fits your needs - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents
• 401(k) with Employer Match - Join the team and we will invest in your future
• Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when you’re not feeling well, to observe holidays
• Wellness - We care about your well-being. From Commuter Benefits to FSAs we’ve got you covered
• Learning & Development - Through continued education/mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional