DRG Appeals Writer
3 weeks ago
Description:
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.
Qualifications:
MINIMUM EDUCATION REQUIRED:
Bachelors 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.
(If no degree, a total of eleven (11) years of experience required).
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.
Coding Certificate program (AHIMA accredited) preferred.
Experience in coding at a multi-facility organization and remote coding experience is a plus.
Masters 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.
LI-POST
#GD
-
RN Appeals Writer
4 weeks ago
Atlanta, United States Piedmont Healthcare Full timeDescription: **Appeal Experience REQUIRED** RESPONSIBLE FOR: Detailed review, analysis and extraction of clinical information from patient medical records and drafting of effective narratives for Medicare and Medicaid appeals documentation and briefs in support of denied cases under appeal at all levels of the government appeals process; maintaining...
-
RN Appeals Writer
3 weeks ago
Atlanta, United States Piedmont Healthcare Corporate Full timeDescription:**Appeal Experience REQUIRED**RESPONSIBLE FOR: Detailed review, analysis and extraction of clinical information from patient medical records and drafting of effective narratives for Medicare and Medicaid appeals documentation and briefs in support of denied cases under appeal at all levels of the government appeals process; maintaining current...
-
RN Appeals Writer
6 days ago
Atlanta, United States Piedmont Healthcare Corporate Full timeDescription:**Appeal Experience REQUIRED**RESPONSIBLE FOR: Detailed review, analysis and extraction of clinical information from patient medical records and drafting of effective narratives for Medicare and Medicaid appeals documentation and briefs in support of denied cases under appeal at all levels of the government appeals process; maintaining current...
-
RN Appeals Writer
7 days ago
Atlanta, United States Piedmont Healthcare Corporate Full timeDescription:**Appeal Experience REQUIRED**RESPONSIBLE FOR: Detailed review, analysis and extraction of clinical information from patient medical records and drafting of effective narratives for Medicare and Medicaid appeals documentation and briefs in support of denied cases under appeal at all levels of the government appeals process; maintaining current...
-
RN Appeals Writer
1 month ago
Atlanta, United States Piedmont Healthcare Corporate Full timeDescription:**Appeal Experience REQUIRED**RESPONSIBLE FOR: Detailed review, analysis and extraction of clinical information from patient medical records and drafting of effective narratives for Medicare and Medicaid appeals documentation and briefs in support of denied cases under appeal at all levels of the government appeals process; maintaining current...
-
RN Appeals Writer
2 weeks ago
Atlanta, United States Piedmont Healthcare Full timeDescription: **Appeal Experience REQUIRED** RESPONSIBLE FOR: Detailed review, analysis and extraction of clinical information from patient medical records and drafting of effective narratives for Medicare and Medicaid appeals documentation and briefs in support of denied cases under appeal at all levels of the government appeals process; maintaining...
-
RN Appeals Writer
1 week ago
Atlanta, United States Piedmont Healthcare Corporate Full timeDescription:**Appeal Experience REQUIRED**RESPONSIBLE FOR: Detailed review, analysis and extraction of clinical information from patient medical records and drafting of effective narratives for Medicare and Medicaid appeals documentation and briefs in support of denied cases under appeal at all levels of the government appeals process; maintaining current...
-
RN Appeals Writer
2 months ago
Atlanta, GA, 30383, DeKalb County, GA, United States Piedmont Healthcare Corporate Full timeDescription:**Appeal Experience REQUIRED**RESPONSIBLE FOR: Detailed review, analysis and extraction of clinical information from patient medical records and drafting of effective narratives for Medicare and Medicaid appeals documentation and briefs in support of denied cases under appeal at all levels of the government appeals process; maintaining current...
-
RN Appeals Writer
6 days ago
Atlanta, Georgia, 30383, DeKalb County, GA, United States Piedmont Healthcare Corporate Full timeDescription:**Appeal Experience REQUIRED**RESPONSIBLE FOR: Detailed review, analysis and extraction of clinical information from patient medical records and drafting of effective narratives for Medicare and Medicaid appeals documentation and briefs in support of denied cases under appeal at all levels of the government appeals process; maintaining current...
-
RN Appeals Writer
3 weeks ago
Atlanta, United States Piedmont Healthcare Corporate Full timeDescription:RESPONSIBLE FOR: Detailed review, analysis and extraction of clinical information from patient medical records and drafting of effective narratives for Medicare and Medicaid appeals documentation and briefs in support of denied cases under appeal at all levels of the government appeals process; maintaining current knowledge base of medical...
-
RN Appeals Writer
6 days ago
Atlanta, United States Piedmont Healthcare Corporate Full timeDescription:RESPONSIBLE FOR: Detailed review, analysis and extraction of clinical information from patient medical records and drafting of effective narratives for Medicare and Medicaid appeals documentation and briefs in support of denied cases under appeal at all levels of the government appeals process; maintaining current knowledge base of medical...
-
RN Appeals Writer
7 days ago
Atlanta, United States Piedmont Healthcare Corporate Full timeDescription:RESPONSIBLE FOR: Detailed review, analysis and extraction of clinical information from patient medical records and drafting of effective narratives for Medicare and Medicaid appeals documentation and briefs in support of denied cases under appeal at all levels of the government appeals process; maintaining current knowledge base of medical...
-
RN Appeals Writer
1 month ago
Atlanta, United States Piedmont Healthcare Corporate Full timeDescription:RESPONSIBLE FOR: Detailed review, analysis and extraction of clinical information from patient medical records and drafting of effective narratives for Medicare and Medicaid appeals documentation and briefs in support of denied cases under appeal at all levels of the government appeals process; maintaining current knowledge base of medical...
-
RN Appeals Writer
2 months ago
Atlanta, GA, 30383, DeKalb County, GA, United States Piedmont Healthcare Corporate Full timeDescription:RESPONSIBLE FOR: Detailed review, analysis and extraction of clinical information from patient medical records and drafting of effective narratives for Medicare and Medicaid appeals documentation and briefs in support of denied cases under appeal at all levels of the government appeals process; maintaining current knowledge base of medical...
-
RN Appeals Writer
6 days ago
Atlanta, Georgia, 30383, DeKalb County, GA, United States Piedmont Healthcare Corporate Full timeDescription:RESPONSIBLE FOR: Detailed review, analysis and extraction of clinical information from patient medical records and drafting of effective narratives for Medicare and Medicaid appeals documentation and briefs in support of denied cases under appeal at all levels of the government appeals process; maintaining current knowledge base of medical...
-
UX Designer
3 weeks ago
Atlanta, United States Brooksource Full timeUX Designer (Newsletter & Email Marketing Specialist) Atlanta, GA (Hybrid) Contract-to-Hire We are seeking a Tactical UI/UX Designer with expertise in newsletter and email marketing design to join our Media & Journalism on a Contract-to-Hire basis. This individual will play a pivotal role in the day-to-day design operations, focusing on the tactical...
-
UX Designer
3 weeks ago
Atlanta, United States Brooksource Full timeUX Designer (Newsletter & Email Marketing Specialist) Atlanta, GA (Hybrid) Contract-to-Hire We are seeking a Tactical UI/UX Designer with expertise in newsletter and email marketing design to join our Media & Journalism on a Contract-to-Hire basis. This individual will play a pivotal role in the day-to-day design operations, focusing on the tactical...
-
User Experience Designer
3 weeks ago
Atlanta, United States Brooksource Full timeTactical Designer (Newsletter & Email Marketing Specialist)Atlanta, GA (Hybrid)Long-Term Contract-to-HireWe are seeking a Tactical UI/UX Designer with expertise in newsletter and email marketing design to join our Media & Journalism on a Contract-to-Hire basis. This individual will play a pivotal role in the day-to-day design operations, focusing on the...
-
Claims ManagerContract
2 months ago
Atlanta, United States Radiant Info Systems Ltd Full timeJob Description Nature of Work: The professional position of Claims Manager requires an experienced, high energy, motivational leader who will effectively provide supervision, leadership, guidance and support for the Client’s Claims and Provider Relations staffs with responsibility including but not limited to claims processing, provider relations,...
-
Claims ManagerContract
1 week ago
Atlanta, United States Radiant Info Systems Ltd Full timeJob Description Nature of Work: The professional position of Claims Manager requires an experienced, high energy, motivational leader who will effectively provide supervision, leadership, guidance and support for the Client’s Claims and Provider Relations staffs with responsibility including but not limited to claims processing, provider relations,...
