1795 IT & Software Developer jobs in the US
Coding appeals specialist
$108,000 - 148,000
St. Luke's University Health Network
American Parkway 1110, Allentown
$108,000 - 148,000
Requirements
Must:
- RHIA, RHIT, and/or CCS credentialing
- Minimum of 5 years of coding experience in an acute care, teaching hospital, inpatient setting
- Strong understanding of ICD-9-CM and ICD-10-CM/PCS diagnosis/procedure coding and MS-DRG assignment
- Demonstrated inpatient and/or outpatient coding experience in acute care environments
- In-depth knowledge of anatomy, physiology, pathophysiology, and medical terminology
- Familiarity with reimbursement systems and regulations regarding documentation and coding
- Proficiency with electronic patient medical records, preferably EPIC
- Experience using the 3M encoding system is advantageous
Responsibilities
- Analyze patient medical records and claims data to assure accurate MS-DRG assignment for appeals
- Conduct retrospective reviews of medical records for accurate diagnosis and procedure coding
- Provide feedback and identify trends to coding and CDMP managers for staff education
- Collaborate with physician liaison on coding issues identified by auditors during reviews
- Develop appeal arguments to challenge coding decisions from external payors
- Draft appeal letters to support network coding initiatives
- Identify clinical documentation improvement needs and communicate resolutions effectively
- Participate in Administrative Law Judge hearings as necessary
- Spend approximately 20% of time coding patient medical records according to guidelines
- Use 3M Encoder to verify diagnosis and procedure code assignments and MS-DRG assignments
- Enter coded records into EPIC while maintaining a 95% accuracy rate
- Query physicians for clarification on ambiguous documentation
Description
At St. Lukes, we take pride in the expertise, experience, and compassion of our workforce, viewing our employees as our greatest asset. Our commitment to excellence drives our mission to care for the sick and injured, educate health care providers, and enhance access to care within our communities. We invite you to join our dedicated team in a role that supports our goals and contributes to improved patient outcomes.
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