Denials Resolution Coding Auditor

Baylor Scott & White Health; Santa Fe (NM); In loco; USD 85.000 - 110.000; Tempo pieno

Vantaggi offerti da questo lavoro

Health benefits

401(k) match

Tuition Reimbursement

PTO

Descrizione del lavoro

Baylor Scott & White Health is seeking a DRC Coding Auditor to partner with multidisciplinary teams to resolve complex coding-related denials for Hospital and Professional Billing claims.

The role requires advanced knowledge of ICD-10-CM/PCS, CPT/HCPCS, DRG methods, and payer policies. You will analyze documentation, develop appeal strategies, and drive denial prevention across revenue cycle operations.

Competenze

• Advanced knowledge of ICD-10-CM, ICD-10-PCS, CPT, HCPCS, DRG assignment and NCCI edits.
• Experience auditing coding denials for HB and PB claims.
• Ability to analyze medical records and support documentation to improve revenue cycle performance.

Mansioni

• Review and audit coding-related denials to determine resolution and appeal strategies.
• Investigate and appeal HB and PB denials including MUE denials and DRG downgrades.
• Prepare and submit clear appeal documentation with supporting guidelines and medical records.
• Communicate findings and trends to leadership to support denial prevention initiatives.
• Maintain audit-ready documentation and adhere to organizational standards.

Conoscenze

Epic proficiency

Encoder software

Payer portals

Excel

Analytical skills

Communication

Documentation skills

Formazione

Health Information Management degree

RHIA/RHIT/CCS/CPC certification

Strumenti

MS Office

Descrizione del lavoro

Baylor Scott & White Health is seeking a DRC Coding Auditor to partner with multidisciplinary teams to resolve complex coding-related denials for Hospital and Professional Billing claims.

The role requires advanced knowledge of ICD-10-CM/PCS, CPT/HCPCS, DRG methods, and payer policies. You will analyze documentation, develop appeal strategies, and drive denial prevention across revenue cycle operations.