Inpatient DRG Appeals Specialist

Universal Health Services; Richmond (VA); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Competitive compensation

Excellent health plans (medical, Rx,/d

401(k) with company match

Job summary

Universal Health Services is seeking an Inpatient Coder for the ARCBO Appeals team. The role focuses on analyzing third-party coding audits, drafting appeal letters, and evaluating clinical documentation to ensure proper DRG assignments.

Responsibilities include reviewing payer audit letters, extracting coding rationales, and providing analysis to the appeals department while ensuring compliance with applicable laws and guidelines.

Qualifications

• High school diploma or equivalent.
• Professional coding certification (CCA, CCS, CCS-P, CPC, RHIT, RHIA) required.
• IP DRG experience a must.
• 1–3 years coding experience; 3–5 years preferred.
• Strong Microsoft Office skills (Excel, Word, Outlook).
• Solid understanding of anatomy, physiology, pharmacology, microbiology and medical terminology.

Responsibilities

• Perform DRG validation reviews in response to third party payer audits.
• Review audit findings to understand audited codes and payer rationale.
• Analyze medical records for supporting documentation of billed diagnoses.
• Write detailed appeal letters to third party payers to prevent downgrades.
• Decide on DRG updates or add-ons based on clinical reviews and criteria.
• Assign DRG audits to nurse auditors when based on clinical criteria.

Skills

MS Office

Medical terminology

Analytical thinking

Education

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

Job description

Universal Health Services is seeking an Inpatient Coder for the ARCBO Appeals team. The role focuses on analyzing third-party coding audits, drafting appeal letters, and evaluating clinical documentation to ensure proper DRG assignments.

Responsibilities include reviewing payer audit letters, extracting coding rationales, and providing analysis to the appeals department while ensuring compliance with applicable laws and guidelines.