INPATIENT CODER

About the Role

The Western Region Consolidated Business Office delivers comprehensive insurance revenue services to our affiliated UHS facilities, encompassing billing, collections, cash posting, pre-access management, variance analysis, and customer service. Our dedication to associate satisfaction and growth is recognized by industry leaders, exemplifying our commitment to fostering a positive and inclusive workplace culture.

Responsibilities

• Perform DRG (Diagnosis Related Group) validation reviews in response to audits from third party payers.
• Review audit findings letters from third party payers to obtain a clear understanding of audited diagnosis codes and underlying payer clinical / coding rationale.
• Analyze medical records to obtain supporting clinical documentation for billed diagnosis codes.
• Write detailed appeal letters based on clinical findings to third party payers to prevent downgrade payment recoveries.
• Make decision to update DRGs or remote or add to billed diagnose codes based on clinical reviews.
• Assign DRG audits to nurse auditors when coding audit is based on clinical criteria.
• Provide analysis and assistance as needed to the appeals department.
• Assist customer service with patient complaints related to coding issues on their medical bills.
• Provide a detailed charge/coding breakdown to assist with medical claims that need to be split billed based on various clinical scenarios.
• Manage multiple spreadsheets including DRG inventory and inventory returned from vendors.
• Maintain educational guidebooks for multiple department workflows.
• Assist with drafting and maintaining appeal letter templates.
• Identify audit trends and provide feedback to management and to UHS acute care facilities.
• Adherence to all applicable laws, regulations and guidelines.
• Other duties as assigned.

Qualifications

• DRG coding expertise with ability to validate and analyze third party coding audits of paid claims.
• Experience drafting detailed appeal letters based on clinical findings.
• Ability to evaluate clinical level of care and review denial trends.
• Capability to analyze medical records and obtain supporting clinical documentation for billed diagnosis codes.
• Skill in managing multiple spreadsheets and maintaining workflow guidebooks.

Benefits

• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ Subsidiaries
• Pet Insurance