Healthcare Coding Specialist
3 days ago
TAL Healthcare is a leading provider of full-service Healthcare Recruitment solutions, connecting top talent with quality healthcare professionals.
Job SummaryWe 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:- Perform concurrent and retrospective clinically based and MS-DRG and APR-DRG validation reviews in compliance with relevant coding and payment regulations.
- Review the correct assignment of ICD-10-CM diagnosis & ICD-10-PCS procedure codes.
- Utilize facility Encoders, EMRs, abstracting systems (e.g., 3M, EPIC), and auditing tools proficiently to make audit determinations.
- Write clear, accurate, and concise rationales supporting audit findings.
- Compose physician queries for clarification of documentation.
- Provide coder education referencing applicable coding references following audits.
- Review DRG/coding denial letters and compose effectively supported appeal response letters to third-party auditors and insurance carriers.
- Provide written recommendations for optimal coding and DRG/SOI assignment.
- Stay up-to-date on regulatory changes affecting coding rules and regulations.
- 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.
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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