Appeals Resolution Coder (Medical Inpatient Coding)

DaMar Staffing; Village of New Hyde Park (NY); On-site; USD 75,000 - 105,000; Full time

Benefits offered by this job

Health insurance

Job summary

DaMar Staffing is recruiting for Revenue Cycle Quality and Performance Management. The role requires inpatient coding or auditing experience with DRGs, and certification-backed credentials.

Responsibilities include denial reviews, data reporting, and maintaining DRG literature familiarity. Strong Excel skills and familiarity with coding denials will support performance improvements.

Qualifications

• Background in Inpatient with 3-5 years' experience in Coding or Auditing.
• Auditing experience with DRGs is highly preferred.
• Familiarity with payer appeals processes and coding denials is desirable.
• Bachelor's degree or equivalent combination of education and experience required.

Responsibilities

• Supports denial reviews and response processes; prioritizes and reviews cases denied by commercial payers.
• Reports program performance and corrective action to management.
• Monitors inpatient denial types and formulates responses; coordinates with legal counsel as needed.
• Addresses coding issues and serves as a resource for litigation related to denials.
• Maintains hospital database and stays up-to-date on DRG literature and coding clinic updates.
• Operates under general guidance with independent decision-making; performs related duties as required.

Education

Bachelor's Degree

Certifications

Job description

Job Title

Revenue Cycle Quality and Performance Management

Job Description

Required: Background in Inpatient with 3-5 years' experience in Coding or Auditing.

Highly Preferred: Auditing experience with DRGs.

Responds to commercial payers, managed care and third party review organizations in managing the appeals/denials process. Supports the review of denial trends and identifies coding issues and knowledge gaps.

Job Responsibility

• Supports denial reviews and response processes; prioritizes and reviews cases denied by commercial payers.
• Reports program performance and/or corrective action to management on regular basis.
• Assists in monitoring inpatient denial types, volume and formulates responses to requesting agency; seeks additional resources (e.g. legal counsel) to resolve issues, as needed; develops case-specific written rationale to substantiate and communicate findings.
• Addresses coding issues and knowledge gaps; functions as a organization resource for litigation as related to coding denials.
• Maintains hospital database.
• Remains up-to-date on DRG system literature from all agencies.
• Maintains coding clinic up-dates.
• Operates under general guidance and work assignments are varied and require interpretation and independent decisions on course of action.
• Performs related duties as required. All responsibilities noted here are considered essential functions of the job under the Americans with Disabilities Act. Duties not mentioned here, but considered related are not essential functions.

Job Qualification

• Bachelor's Degree required, or equivalent combination of education and related experience.
• Current Professional Coder Certification, or Current Coding Professional Certification, or Current Registered Health Information Technician Certification required, plus specialized certifications as needed.
• 1-3 years of relevant experience, required.
• Knowledgeable on DRGs, preferred.
• Proficient in Microsoft Excel, preferred.

*Additional Salary Detail The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).