Inpatient DRG Appeals Specialist

Universal Hospital Services Inc.; Las Vegas (NV); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Competitive pay

Generous PTO

Excellent medical/dental/vision plans

401(k) with company match

SoFi student loan refinancing program

Career development opportunities

Job summary

Universal Health Services (UHS) WCBO seeks a dynamic Inpatient Coder for the Appeals department to analyze third party coding audits, draft detailed appeal letters, and review denial trends. The role involves DRG validation, interpreting payer rationale, and ensuring accurate reimbursements.

You will collaborate with nurse auditors and patient services while maintaining compliance with applicable laws and guidelines. Competitive benefits and professional growth opportunities are provided.

Qualifications

• DRG coding expertise and familiarity with audits.
• Ability to draft appeal letters and analyze payer rationale.
• Strong knowledge of medical record documentation.

Responsibilities

• Perform DRG validation reviews in response to audits from third party payers.
• Review audit findings letters from third party payers to understand audited codes and rationale.
• Analyze medical records to obtain supporting clinical documentation for billed diagnosis codes.
• Write detailed appeal letters based on clinical findings to third party payers to prevent downgrade payments.
• Make decisions to update DRGs or add/remove 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 as needed.
• Assist customer service with patient complaints related to coding issues on medical bills.
• Provide a detailed charge/coding breakdown to assist with split billing scenarios.

Job description

Universal Health Services (UHS) WCBO seeks a dynamic Inpatient Coder for the Appeals department to analyze third party coding audits, draft detailed appeal letters, and review denial trends. The role involves DRG validation, interpreting payer rationale, and ensuring accurate reimbursements.

You will collaborate with nurse auditors and patient services while maintaining compliance with applicable laws and guidelines. Competitive benefits and professional growth opportunities are provided.