DRG Appeals Coder — Inpatient Billing & Audit Expert

Talentify; Richmond (VA); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Medical, Dental, Vision

401(k) with company match

SoFi Student Loan Refinancing Program

Pet Insurance

Career development opportunities

Job summary

Universal Health Services (UHS) seeks an Inpatient Coder for the Atlantic Region CBO to analyze third party audits, draft appeal letters, and review clinical level of care. The role focuses on DRG validation, understanding payer rationale, and supporting the appeals team with accurate coding analyses.

You will work within the ARCBO to maintain DRG inventories, assist with customer service, and ensure compliance with guidelines across UHS facilities.

Qualifications

• High school diploma or equivalent.
• Professional coding certification (CCA/CCS/CCS-P/CPC/RHIT/RHIA) or equivalent.
• IP DRG experience with coding background.
• 1–3 years coding; 3–5 years preferred.
• Strong MS Office skills (Excel, Word, Outlook).
• Anatomy, physiology, pharmacology and medical terminology knowledge.
• Familiarity with appeals and healthcare business office experience preferred.

Responsibilities

• Perform DRG validation reviews in response to third party audits.
• Review audit findings letters to understand coded diagnoses and payer rationale.
• Analyze medical records to obtain supporting clinical documentation.
• Write detailed appeal letters to third party payers to prevent downgrades.
• Decide to update DRGs or add codes based on clinical reviews.
• Assign DRG audits to nurse auditors when needed.
• Provide analysis and support to the appeals department.
• Assist customer service with coding-related patient inquiries.
• Provide detailed charge/coding breakdowns for split billing scenarios.
• Maintain DRG inventory and related spreadsheets.
• Keep educational guides for department workflows updated.
• Draft and maintain appeal letter templates.
• Identify audit trends and report to management and facilities.
• Comply with applicable laws, regulations and guidelines.

Skills

DRG coding

Microsoft Office

Anatomy knowledge

Appeals process understanding

Audit analysis

Education

High school diploma or equivalent

Professional coding certification (CCA, CCS, CCS-P, CPC, RHIT, RHIA)

Tools

Excel

Word

Outlook

Job description

Universal Health Services (UHS) seeks an Inpatient Coder for the Atlantic Region CBO to analyze third party audits, draft appeal letters, and review clinical level of care. The role focuses on DRG validation, understanding payer rationale, and supporting the appeals team with accurate coding analyses.

You will work within the ARCBO to maintain DRG inventories, assist with customer service, and ensure compliance with guidelines across UHS facilities.