Clinical Coding Analyst

Shelby American, Inc.; Largo (FL); Remote; USD 60,000 - 100,000; Full time

Job summary

An established industry player is seeking a Clinical Coding Analyst who is a credentialed coder or HIM professional. This role involves performing DRG audits, inpatient chart reviews, and appealing payor denials. The ideal candidate will have significant experience in coding and must articulate compelling arguments to refute payor assertions. Join a passionate team dedicated to improving hospital operations and outcomes, where your expertise will contribute to optimizing clinical revenue cycles and enhancing community health. If you have a strong coding background and enjoy working in a collaborative environment, this opportunity is perfect for you.

Qualifications

• 5+ years of inpatient coding or MS-DRG auditing experience.
• Expert knowledge of ICD-10-CM/PCS Guidelines for Coding.

Responsibilities

• Monitor and manage DRG review and denials work queues.
• Draft detailed appeal letters citing clinical guidelines and coding standards.

Skills

High level coding expertise

Oral and written communication skills

Analytical skills

Computer skills

Denials management

Education

CCS

CDIP

CCDS

RHIT

RHIA

RN

Tools

Electronic Health Records

Job description

Description

The Clinical Coding Analyst is a credentialed coder, HIM professional or Registered Nurse with significant experience performing DRG audits and/or appeals. The Clinical Coding Analyst will perform inpatient chart reviews to identify coding opportunities that may impact DRG assignment or draft letters to appeal payor DRG denials. Each day may include a mix of these activities or may primarily focus on one or the other activities depending on case volumes.

DRGs review include identification of revenue opportunities as well as coding and compliance risks. The appeals process includes reviewing the payor denial and authoring appeal letters when appropriate. The analyst should have expert knowledge of the Official ICD 10-CM/PCS Guidelines for Coding and Reporting and AHA Coding Clinics. In addition to strong coding knowledge, the Clinical Coding Analyst must be able to concisely articulate compelling, well-written, professional arguments to refute the payor’s assertion.

About Us

At Brundage Group, we believe hospitals are a vital part of our communities. Our team is passionate about improving the health of our hospital clients through our advisory, analytics and staffing solutions. We aim to be an essential partner to our hospital clients in optimizing their clinical revenue cycle operations and outcomes, so they can continue to serve our communities.

Requirements

• Monitors and manages DRG review and DRG denials work queues to ensure timely completion of deliverables within company standards.
• Review DRG-related claim denials and downgrades.
• Analyze medical records and denial explanations to determine appeal viability.
• Draft detailed and evidence-based appeal letters citing clinical guidelines, coding standards (ICD-10, CPT, MS-DRG), and payer policies.
• Perform chart reviews to identify coding opportunities, documentation opportunities, potential coding compliance issues, or assess if there is sufficient evidence to refute payor denials.
• Perform validation reviews with the supervising Physician Advisor for all reviewed records.
• Collaborate with a Physician Advisor on authored appeals.
• Perform all chart reviews within 2 business days of receipt of case.
• Provide input and recommendations to Brundage Group management for process improvement.
• Demonstrate the ability to use proper grammar and punctuation when constructing written communication that clearly identifies the issue when performing DRG audits or refutes the payor’s findings when authoring an appeal.
• Ensure all client deliverables are professional and properly formatted using Brundage Group templates with company fonts, colors, etc.
• Maintain IT access to client sites and know how to escalate IT issues that can negatively impact the ability to perform assigned duties to avoid downtime.
• Maintain HIPAA and all other privacy compliance standards as required by Federal law, State law or Brundage Group.
• Maintain relevant credentials required for the role e.g., RN, RHIA, RHIT, CCS, CDIP, CCDS, etc. as well as current knowledge of AHA coding clinic and ICD-10-CM/PCS code changes.
• Participation in client calls to support the client relationship and company meetings as needed.
• Work collaboratively with operations, client engagement and the supervising physician advisor to ensure cases are received in a timely manner and processed accordingly to meet deadlines.
• Responsibility for other duties as assigned or requested.

KNOWLEDGE, SKILLS, AND ABILITIES: Abilities may be accessed through written, verbal, and other evaluation methods.

• High level coding expertise.
• At least 5 years of recent inpatient coding experience or MS-DRG auditing experience and at least 2 years’ experience in denials management and authoring appeal letters.
• Strong computer skills.
• Consulting experience preferred.
• Experience with CDI or as a second level reviewer preferred.
• Must have strong oral and written communication skills.
• Ability to work independently in a remote environment and collaborate well with other departments.

WORK EXPERIENCE, EDUCATION AND CERTIFICATIONS:

• Credentials: a combination of any of the following: CCS, CDIP, CCDS, RHIT, RHIA, RN.
• Experience with multiple Electronic Health Records preferred.

WORKING CONDITIONS AND PHYSICAL REQUIREMENTS:

Conditions typically associated with an office environment. While performing the essential duties and responsibilities, the employee is regularly required to talk or hear. May be frequently required to sit, stand or walk. Moderate to prolonged reading, typing, and computer work. Ability to perform tasks involving physical activity that may include lifting to 25 pounds. Subject to exposure to all environmental hazards associated with healthcare and office work.