Coding Appeals Specialist: Lead DRG Appeals & Documentation

St. Luke’s University Health Network; Allentown, Northern (Lehigh County, KY); On-site; USD 85,000 - 110,000; Full time

Job summary

St. Luke's University Health Network seeks a Coding Appeals Specialist to review patient records and ensure accurate MS-DRG coding for appeals.

You will analyze ICD-10-CM/PCS coding, draft appeal letters, and collaborate with clinicians to resolve documentation issues. The role requires at least 5 years of inpatient/outpatient coding in an acute care or teaching hospital setting, with strong knowledge of ICD-10-CM/PCS, MS-DRG assignment, and reimbursement rules.

Qualifications

• Minimum 5 years demonstrated inpatient and/or outpatient coding experience in acute care, teaching setting.
• Knowledge of anatomy and physiology, pathophysiology, and medical terminology required.
• Working knowledge of ICD-10-CM/PCS and ability to understand complex disease processes strongly preferred.

Responsibilities

• Conduct retrospective medical record reviews for diagnosis and procedure code assignment and MS-DRG accuracy.
• Identify and provide feedback to education of staff and coding professionals on documentation issues affecting coding and reimbursement.
• Draft appeal letters and coding arguments to support network coding and defend coding determinations against payors.

Skills

Medical coding

Inpatient coding

MS-DRG assignment

Education

RHIA, RHIT and/or CCS

Tools

EPIC

3M Encoder

Job description

St. Luke's University Health Network seeks a Coding Appeals Specialist to review patient records and ensure accurate MS-DRG coding for appeals.

You will analyze ICD-10-CM/PCS coding, draft appeal letters, and collaborate with clinicians to resolve documentation issues. The role requires at least 5 years of inpatient/outpatient coding in an acute care or teaching hospital setting, with strong knowledge of ICD-10-CM/PCS, MS-DRG assignment, and reimbursement rules.