Inpatient Coder – Appeals DRG Specialist (Remote)

University of Minnesota School of Nursing; Northern (KY); Hybrid; USD 52,000 - 77,000; Full time

Benefits offered by this job

Competitive compensation

Generous PTO

Medical, dental, vision plans

401(k) with company match

Student loan refinancing program

Career development opportunities

Pet Insurance

Benefits website

Job summary

Universal Health Services in the Western Region is seeking an Inpatient Coder for the Appeals department. The DRG Coder analyzes third party coding audits, drafts appeal letters, and reviews clinical care levels to prevent downgrades, with remote or in-office work options.

Compensation ranges from $24.80 to $37.20 per hour based on experience and full-time status. The role requires CCS certification, DRG expertise, and 1–3 years coding experience (3–5 years preferred).

Qualifications

• High school diploma or equivalent.
• Professional coding certification CCS (Required), CCA, CCS-P, CPC, RHIT, RHIA preferred.
• IP DRG experience.
• 1-3 years coding experience, 3-5 years preferred.
• Strong Microsoft Office skills (Excel, Word, Outlook).
• Understanding of anatomy, physiology, pharmacology, microbiology and medical terminology.
• Familiarity with appeals and healthcare business office experience preferred.

Responsibilities

• Perform DRG validation reviews in response to audits from third party payers.
• Review audit findings letters to obtain understanding of audited diagnosis codes and payer rationale.
• Analyze medical records to obtain supporting clinical documentation for billed diagnosis codes.
• Write detailed appeal letters based on clinical findings to payers.
• Make decisions to update DRGs or add to billed diagnosis codes based on clinical reviews.
• Assign DRG audits to nurse auditors when coding audit is based on clinical criteria.
• Provide analysis and assistance to the appeals department.
• Assist customer service with patient complaints related to coding issues on bills.
• Provide a detailed charge/coding breakdown to assist with split billing.
• Manage multiple spreadsheets including DRG inventory and vendor returns.
• Maintain educational guidebooks for department workflows.
• Draft and maintain appeal letter templates.
• Identify audit trends and provide feedback to management and facilities.

Education

CCS Certification

Additional certifications (CCA, CCS-P, CPC, RHIT, RHIA)

Job description

Universal Health Services in the Western Region is seeking an Inpatient Coder for the Appeals department. The DRG Coder analyzes third party coding audits, drafts appeal letters, and reviews clinical care levels to prevent downgrades, with remote or in-office work options.

Compensation ranges from $24.80 to $37.20 per hour based on experience and full-time status. The role requires CCS certification, DRG expertise, and 1–3 years coding experience (3–5 years preferred).