CODING/CDI DENIALS ANALYST

The University of Texas Southwestern Medical Center; Dallas (TX); On-site; USD 65,000 - 90,000; Full time

Job summary

UT Southwestern Medical Center in Dallas, TX, is seeking a Coding/CDI Denials Analyst to review inpatient coding denials for accuracy and compliance with Official Coding Guidelines. The role involves composing appeals, identifying trends, and communicating opportunities for process improvement to the Coding & CDI teams.

The ideal candidate has 3-5 years of acute hospital coding/CDI experience, plus RHIA or RHIT or CCS/CDIP/CDDS certifications, and experience working in a remote environment.

Qualifications

• 3-5 years acute hospital-based Coding and/or CDI experience
• Denials and Appeals experience in an acute Hospital setting
• Experience working in a remote environment

Responsibilities

• Review coding and/or clinical denials, ensuring guidelines and conventions are followed and clinical evidence supports codes and DRG
• Compose appeals using coding guidelines and clinical documentation
• Identify coding/documentation trends for root causes of denials
• Identify DRG changes and financial impact
• Report educational opportunities to Lead Denials Analyst
• Identify front-end activities influencing denial/appeals process
• Support Quality Standards set by UTSW HIM Coding & CDI Department
• Maintain expert knowledge of Coding/CDI guidelines and practices
• Other duties as assigned

Skills

Denials & Appeals

Coding

Remote work experience

Education

RHIA Certification

RHIT Certification

CCS Certification

CDDS Certification

CDIP Certification

Job description

WHY UT SOUTHWESTERN?

With over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern is committed to excellence, innovation, teamwork, and compassion. As a world-renowned medical and research center, we strive to provide the best possible care, resources, and benefits for our valued employees. Ranked as the number 1 hospital in Dallas-Fort Worth according to U.S. News & World Report, we invest in you with opportunities for career growth and development to align with your future goals. Our highly competitive benefits package offers healthcare, PTO and paid holidays, on-site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you'll discover a culture of teamwork, professionalism, and a rewarding career!

JOB SUMMARY

The Coding/CDI Denials Analyst primary responsibilities are to review coding denials for inpatient hospital medical records, for accuracy of assigned codes, and ensure all Official Coding Guidelines and conventions were followed. Also, to ensure the clinical evidence and provider documentation supports the assigned codes and DRG. Compose and submit appeal letters as appropriate, identify coding trends/opportunities for root causes of denials, which would be relevant for additional education to individual Coders/CDI Specialist's and/or the entire Coding/CDI Teams. Report these trends/opportunities to the Lead Denials Analyst to ensure education is developed and provided to the Coders and/or CDI Teams. Identify and communicate front-end activities that influence the denials/appeals process, seeking opportunities for process improvement.

BENEFITS

UT Southwestern is proud to offer a competitive and comprehensive benefits package to eligible employees. Our benefits are designed to support your overall wellbeing, and include:

• PPO medical plan, available day one at no cost for full-time employee-only coverage
• 100% coverage for preventive healthcare-no copay
• Paid Time Off, available day one
• Retirement Programs through the Teacher Retirement System of Texas (TRS)
• Paid Parental Leave Benefit
• Wellness programs
• Tuition Reimbursement
• Public Service Loan Forgiveness (PSLF) Qualified Employer
• Learn more about these and other UTSW employee benefits!

EXPERIENCE AND EDUCATION

Required

Experience

• 3 years three to five (3-5) year's acute hospital-based Coding and/or CDI experience or
• An equivalent combination of education and experience may be considered
• Denials and Appeals experience in an acute Hospital setting and
• Experience working in a remote environment

Licenses and Certifications

• (RHIA) REGD HEALTH INFO ADMINIST or
• (RHIT) REGD HEALTH INFO TECHNOLO or
• (CCS) CERT CODING SPECIALIST or
• (CCDS) Cert Clinical Documentation or
• (CDIP) CERT DOCUMNTATN IMPROVMNT PRAC

Preferred

• RN with CDI experience

JOB DUTIES

• Review coding and/or clinical denials, ensuring all coding guidelines and conventions were followed, and ensuring all clinical evidence and provider documentation supports the assigned codes and DRG.
• Compose an effective appeal utilizing appropriate coding guidelines, relevant and effective clinical documentation, current industry guidelines, evidence-based medicine, and local and national medical management standards and protocols.
• Identify coding and/or documentation trends for root causes of denials.
• Identify and communicate DRG changes and financial impact.
• Identify coding and clinical educational opportunities and report these to the Lead Denials Analyst.
• Identify front-end activities that influence denial/appeals process.
• Support the Quality Standards set by UTSW and the HIM Coding & CDI Department.
• Maintains an expert level of knowledge of Coding/CDI guidelines and practices.
• Other duties as assigned.

SECURITY AND EEO STATEMENT

Security

This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information.

EEO

UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status.