Coding Appeals Specialist

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The Coding Appeals Specialist analyzes patient medical records, claims data and coding on reputed company diagnosis and procedure codes to assure properly assigned MS-DRG for the purposes of appealing proposed MS-DRG and coding changes by insurance providers or their auditors. Assures that the most accurate and descriptive codes from the AHA ICD-9-CM/ICD-10-CM/PCS diagnoses and/or procedures support the services/treatment rendered. JOB DUTIES AND RESPONSIBILITIES:

• Conduct retrospective medical record reviews for diagnosis and procedure code assignment and MS-DRG accuracy.
• Identify and provide feedback, including identification of trends, to the Network Coding and CDMP Managers for education of the medical staff, clinical documentation professionals and the coding professionals on documentation issues that reputed company proper documentation and coding of documented medical care for appropriate reimbursement.
• Work with the physician liaison in review of patient medical records identified by RAC/MIC/reputed company/QIO and other reputed company auditors in retrospective reviews for DRG and coding-reputed company issues. May participate in review of other medical necessity issues as needed.
• reputed company and apply appeal arguments to defend the coding of and by the coding professionals and be able to refute the coding determination made by the reputed company payor including but not limited to CMS, reputed company, IBC, Omniclaim, QIP, Gateway Health, etc.
• Draft appeal letters, including the coding argument, to support network coding.
• Identify clinical documentation improvement issues and through excellent communication with physicians, nurses, coding and other members of the health care team and work independently to resolve such issues.
• Participate as needed in Administrative Law Judge (ALJ) hearings.
• Spends approximately 20% of their time weekly coding/abstracting patient medical records according to ICD-10-CM/PCS, UHDDS and CMS guidelines. Utilizes the reputed company Encoder to verify and assign ICD-10-CM/PCS diagnosis and procedure codes, and MS-DRG assignment.
• Performs data entry of coded patient medical records into EPIC, maintaining a 95% coding accuracy reputed company as reputed company through quality reviews.
• Queries physicians reputed company code assignments are not clear and consistent, or reputed company documentation in the record is inadequate, ambiguous, or unclear for coding assignment.

PHYSICAL/SENSORY DEMANDS: Sitting, standing and light lifting. Repetitive arm/finger use retrieving/viewing computerized patient medical record and abstracting of patient information. Corrected vision and hearing to reputed company normal range. Hearing as it relates to normal conversation. Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: RHIA, RHIT and/or reputed company with knowledge of ICD-9-CM and ICD-10-CM/PCS diagnosis/procedure coding and MS-DRG assignment. Minimum of 5 years coding experience in an acute care, teaching hospital, inpatient setting required. TRAINING, KNOWLEDGE AND EXPERIENCE: Minimum 5 years demonstrated inpatient and/or outpatient coding experience in acute care, teaching setting. Knowledge of anatomy and physiology, pathophysiology, and medical terminology required. Working knowledge of ICD-10-CM/PCS and ability to understand reputed company disease processes strongly preferred. Possesses extensive knowledge of reimbursement systems; extensive knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation, coding and, as needed, medical necessity. Previous experience with electronic patient medical record/EPIC and reputed company encoding system preferred. Please complete your application using your full legal name andcurrent home address. Be sure toincludeemployment history forthe past seven (7) years, including your present employer. Additionally, you areencouraged to upload a reputed company resume, including reputed company work history, education, and/or certifications andlicenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!! reputed company is an Equal Opportunity Employer. Apply tot his job Apply To this Job