Inpatient Coder: DRG Appeals & Audit Expert

Universal Hospital Services Inc.; Richmond (VA); On-site; USD 63,000 - 88,000; Full time

Benefits offered by this job

Excellent Medical, Dental, Vision and

401(K) with company match

SoFi Student Loan Refinancing Program

Pet Insurance

Job summary

Universal Health Services is seeking an Inpatient Coder for the Appeals department within the Atlantic Region CBO to analyze third party coding audits, draft appeal letters, and review denial trends.

The role requires DRG validation, review of audit findings, and analysis of medical records to justify coding decisions; responsibilities include drafting detailed appeal letters to prevent payment downgrades and supporting the appeals team.

Qualifications

• High school diploma or equivalent.
• Professional coding certification required (one of the listed)
• IP DRG experience preferred
• 1-3 years coding experience, 3-5 years preferred
• Familiarity with appeals and healthcare business office experience a plus

Responsibilities

• Perform DRG validation reviews in response to third party payer audits.
• Review audit findings letters to understand audited codes and payer rationale.
• Analyze medical records to obtain supporting clinical documentation.
• Write detailed appeal letters to third party payers to prevent downgrades.
• Decide on updating DRGs or adding to billed diagnoses based on clinical reviews.
• Assign DRG audits to nurse auditors when needed.
• Assist appeals department and customer service with coding issues on bills.
• Provide detailed charge/coding breakdowns for split billing scenarios.
• Manage DRG inventory and vendor returns.

Skills

IP DRG experience

1-3 years coding experience

Microsoft Office skills

Anatomy & medical terminology

Familiarity with appeals processes

Education

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

Tools

Microsoft Excel

Word

Outlook

Job description

Universal Health Services is seeking an Inpatient Coder for the Appeals department within the Atlantic Region CBO to analyze third party coding audits, draft appeal letters, and review denial trends.

The role requires DRG validation, review of audit findings, and analysis of medical records to justify coding decisions; responsibilities include drafting detailed appeal letters to prevent payment downgrades and supporting the appeals team.