DRG Audit & Denials Specialist, HIM

Jackson Health System; Miami (FL); On-site; USD 60,000 - 80,000; Full time

Job summary

Jackson Health System in Miami, FL seeks a Clinical Coding Audit Specialist for a full-time role. The specialist will ensure accurate Diagnosis Related Group (DRG) assignments, oversee audits, and collaborate with clinical teams for compliance. The job requires an Associate's degree, preferably with foreign physician experience, and AHIMA certification. The ideal candidate will have 5-7 years of experience in clinical coding and possess strong analytical communication skills. This role is crucial for maintaining regulatory compliance and improving reimbursement processes.

Qualifications

• 5 to 7 years of related experience required.
• Certification from AHIMA, AAPC, or ACDIS is required.

Responsibilities

• Perform reviews of DRG downgrades and payer denials to validate clinical documentation.
• Validate DRG assignments according to guidelines and policies.
• Conduct audits of inpatient coding and DRG assignments.

Skills

Ability to analyze, organize and prioritize work accurately while meeting multiple deadlines

Ability to communicate effectively in both oral and written form

Ability to handle difficult and stressful situations with critical thinking

Knowledge and skill in use of job appropriate technology and software applications

Education

Associate's degree in related field

Foreign Physician preferred

Tools

AHIMA certification (e.g., RHIA, RHIT, CCS)

Valid Florida RN license (preferred)

Job description

Jackson Health System in Miami, FL seeks a Clinical Coding Audit Specialist for a full-time role. The specialist will ensure accurate Diagnosis Related Group (DRG) assignments, oversee audits, and collaborate with clinical teams for compliance. The job requires an Associate's degree, preferably with foreign physician experience, and AHIMA certification. The ideal candidate will have 5-7 years of experience in clinical coding and possess strong analytical communication skills. This role is crucial for maintaining regulatory compliance and improving reimbursement processes.