Healthcare Coding Specialist

3 days ago


New York, New York, United States TAL Healthcare Full time
Overview

TAL Healthcare is a leading provider of full-service Healthcare Recruitment solutions, connecting top talent with quality healthcare professionals.

Job Summary

We are seeking a skilled Healthcare Coding Specialist - DRG Validator to join our team. The successful candidate will be responsible for auditing inpatient medical records, ensuring the accuracy of coding, provider documentation, and DRG assignment.

Main Responsibilities:
  1. Perform concurrent and retrospective clinically based and MS-DRG and APR-DRG validation reviews in compliance with relevant coding and payment regulations.
  2. Review the correct assignment of ICD-10-CM diagnosis & ICD-10-PCS procedure codes.
  3. Utilize facility Encoders, EMRs, abstracting systems (e.g., 3M, EPIC), and auditing tools proficiently to make audit determinations.
  4. Write clear, accurate, and concise rationales supporting audit findings.
  5. Compose physician queries for clarification of documentation.
  6. Provide coder education referencing applicable coding references following audits.
  7. Review DRG/coding denial letters and compose effectively supported appeal response letters to third-party auditors and insurance carriers.
  8. Provide written recommendations for optimal coding and DRG/SOI assignment.
  9. Stay up-to-date on regulatory changes affecting coding rules and regulations.
Requirements
  • One of the following AHIMA certifications: CCS, RHIT, or RHIA.
  • Extensive knowledge of medical terminology, anatomy, coding terminology, and coding guidelines for ICD-10-CM/PCS, CPT, Modifiers, etc.
  • Equivalent experience of 5+ years in DRG/Clinical Validation claims auditing, quality assurance, or recovery auditing.
  • Minimum of 5+ years working with ICD-10-CM/PCS, MS-DRG, and APR-DRG with a broad knowledge of medical claims billing/payment systems, and payer reimbursement policies.
  • Adherence to Official Coding Guidelines for Coding and Reporting, Coding Clinic determinations, CMS, and other regulatory compliance guidelines and mandates.
  • Demonstrated basic skills in Microsoft Outlook, Word, Excel, PowerPoint, 3M, TruCode, Teams, SharePoint, and other applications.
Benefits

We offer a competitive salary range of $90,000-$120,000 per year, depending on experience. Our benefits package includes health insurance, retirement plan, paid time off, and opportunities for professional growth and development.



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