DRG Appeals Specialist

1 week ago

Orange, California, United States UC Irvine Health Full time $60,000 - $100,000 per year

Overview:

UCI Health is the clinical enterprise of the University of California, Irvine, and the only academic health system based in Orange County. UCI Health is comprised of its main campus, UCI Medical Center, a 459-bed, acute care hospital in in Orange, Calif., four hospitals and affiliated physicians of the UCI Health Community Network in Orange and Los Angeles counties and ambulatory care centers across the region. Listed among America's Best Hospitals by U.S. News & World Report for 23 consecutive years, UCI Medical Center provides tertiary and quaternary care and is home to Orange County's only National Cancer Institute-designated comprehensive cancer center, high-risk perinatal/neonatal program and American College of Surgeons-verified Level I adult and Level II pediatric trauma center, gold level 1 geriatric emergency department and regional burn center. UCI Health serves a region of nearly 4 million people in Orange County, western Riverside County and southeast Los Angeles County.

To learn more about UCI Health, visit

Responsibilities:

Position Summary:

The DRG Appeals Specialists will review and analyze denied/downgraded MS DRG and APR-DRG accounts received from payers (e.g. Medicare, Commercial and Third Party). Using coding expertise the specialist will determine if the denied/downgraded account is appealable. When applicable the specialist will prepare an appeal letter based on current coding guidelines and clinical criteria, as well as track and trend denial root causes so documentation/coding opportunities for improvement are identified.

Qualifications:

Required Qualifications:

  • Previous experience in reviewing and processing appeals
  • Previous experience and Knowledge of MS-DRG and APR-DRG structures and payment methodology
  • Knowledge of the AHA official coding guidelines
  • Knowledge of anatomy and physiology, disease process and medical terminology
  • Knowledge of RAC, Medicare guidelines (LCD's and NCD's) and payer appeal processes and stages
  • Knowledge of ICD-10 CM and ICD-10 PCS coding conventions
  • Excellent written and verbal communication skills in English
  • Excellent organizational skills and attention to detail
  • Electronic Health Record experience 3M, Epic
  • CCS credential
  • 5 years inpatient coding experience

Preferred Qualifications:

  • Working knowledge of Clinical Documentation Improvement
  • Prior denial management experience
  • Prior EPIC experience
  • Coding experience in an acute care academic setting
  • Clinical background preferred

Total Compensation

We offer a wealth of benefits to make working at UCI even more rewarding. These benefits may include medical insurance, sick and vacation time, retirement savings plans, and access to a number of discounts and perks. Please utilize the links listed here to learn more about our compensation practices and benefits.

Conditions of Employment:

The University of California, Irvine (UCI) seeks to provide a safe and healthy environment for the entire UCI community. As part of this commitment, all applicants who accept an offer of employment must comply with the following conditions of employment:

  • Background Check and Live Scan
  • Employment Misconduct*
  • Legal Right to Work in the United States
  • Vaccination Policies
  • Smoking and Tobacco Policy

  • Drug Free Environment

  • Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.

The following additional conditions may apply, some of which are dependent upon business unit or job specific requirements.

  • California Child Abuse and Neglect Reporting Act
  • E-Verify
  • Pre-Placement Health Evaluation

Details of each policy may be reviewed by visiting the following page:

Closing Statement:

The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected categories covered by the UC Anti-Discrimination Policy.

We are committed to attracting and retaining a diverse workforce along with honoring unique experiences, perspectives, and identities. Together, our community strives to create and maintain working and learning environments that are inclusive, equitable, and welcoming.

UCI provides reasonable accommodations for applicants with disabilities upon request. For more information, please contact UCI's Employee Experience Center (EEC) at or at , Monday - Friday from 8:30 a.m. - 5:00 p.m.

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