DRG Appeals Writer
2 weeks ago
JOB PURPOSE:
The individual in this position on behalf of the entire Piedmont System will be responsible for managing the administrative appeal of reimbursement claims denied by Medicare or Medicaid on the grounds that the medical coding was incorrect.
These duties involve coordination of activities with the managers of coding at each of the Piedmont affiliated hospitals and physician practices as well as the Senior Director of Government Appeals.
The incumbent must maintain a high level of understanding of DRGs and MS/DRGs.ICD-9-CM Official Guidelines for Coding and Reporting, American Hospital Association Coding Clinic guidelines, federal guidelines for coding Medicare inpatient records, state guidelines for coding Medicaid records, Utilization Review ("UR") regulations and Medicare guidelines regarding medical necessity, inpatient, outpatient and observation.
In the context of managing the appeals, the incumbent will be responsible for resolving differences of opinions among coders as to the most appropriate code.
The incumbent will be responsible for preparing the coding appeals; performing a detailed review, analysis and extraction of clinical and coding information from patient medical records and drafting effective narratives for Medicare and Medicaid appeals briefs in support of denied cases throughout appeals at all levels of the government appeals process.
In addition, the incumbent will be qualified and available to testify in appeal hearing before an administrative law judge as an expert in medical coding.
MINIMUM EDUCATION REQUIRED:
Bachelor's degree required.
In lieu of degree, six (6) years of relevant work experience will be accepted in addition to the experience requirement.
MINIMUM EXPERIENCE REQUIRED:
Five (5) years of inpatient coding experience and of DRG-MS/DRG auditing experience in a healthcare setting.
Experienced medical record/DRG coder/auditor with a working knowledge of ICD-10 guidelines, case management, government and contracted payers.
Must be experienced in clinical, coding and patient financial services software such as 3-M Encoder, SCM / Quest, STAR, EPIC, Client Tracking, and I-Suites.
MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:
None.
ADDITIONAL QUALIFICATIONS:
One or more certifications required - Registered Health Information Management Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), CCA, CCS-P, CPC, CPC-H.
Experience in coding at a multi-facility organization and remote coding experience is a plus.
Master's degree and previous experience writing DRG Appeals preferred.
Previous experience with RAC claims denials preferred.
Microsoft Word and Excel proficiency preferred.
HealthPort AudaPro systems experience a plus.
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