CODING/CDI DENIALS ANALYST

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

Benefits offered by this job

PPO medical plan

100% coverage for preventive care

Paid Time Off

TRS retirement program

Paid parental leave

Wellness programs

Tuition reimbursement

PSLF-qualified employer

Job summary

UT Southwestern Medical Center in Dallas, TX is seeking a Coding/CDI Denials Analyst to review inpatient coding denials for accuracy and to ensure supporting documentation aligns with Official Coding Guidelines and DRG assignments.

The role includes composing appeals, identifying trends for root causes of denials, and communicating findings to support process improvements across Coders and CDI teams.

Qualifications

• 3 years to 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 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.

Skills

Coding/CDI experience

Denials & Appeals

Remote work experience

Education

RHIA

RHIT

CCS

CCDS

CDIP

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

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

Preferred

Experience

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.