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Senior Inpatient Coding Specialist

3 weeks ago

Phoenix, Arizona, United States Lm2 Resource Solutions Full time
Job Overview

We are seeking a highly skilled Senior Inpatient Coding Specialist to join our team at Lm2 Resource Solutions. As a key member of our coding team, you will be responsible for conducting retrospective reviews of medical claims, performing diagnosis and procedural coding for inpatient claims, and serving as a subject matter expert for medical claims coding related to both outpatient and inpatient services.

Key Responsibilities
  • Coding Expertise: Conduct retrospective reviews of medical claims to determine appropriate coding and pricing. Perform diagnosis and procedural coding for inpatient claims with DRG (Diagnosis-Related Grouping) assignment. Serve as a subject matter expert for medical claims coding related to both outpatient and inpatient services.
  • Collaboration and Support: Provide coding-related information to medical directors, providers, peer reviewers, and other stakeholders. Assist non-clinical and clinical staff with coding and retrospective claims review processes.
  • Network and Provider Relations: Act as the designated recipient for factual network provider claim review requests. Develop determination letters as part of the review process.
  • Internal Coordination: Work closely with Claims, Administration, Program Integrity, Quality Management, and subcontractors to ensure accurate coding and claims processing.
Requirements
  • Experience: Strong background in inpatient coding and comprehensive understanding of DRG coding.
  • Certifications: HRIT (Health Record Information Technology) and HRIA (Health Record Information Administration).
  • Leadership: Ability to work under the direction of a DRG Supervisor or designee, demonstrating both independence and collaborative skills.
Compensation and Benefits

The estimated salary for this position is $60,000 - $80,000 per annum, based on industry standards and location. Our company offers competitive benefits, including health insurance, retirement plans, and paid time off.