Remote Inpatient Coding Auditor & DRG Expert

AdventHealth; Town of Florida (NY); On-site; USD 36,000 - 68,000; Full time

Benefits offered by this job

Medical, Dental, Vision Insurance

Life Insurance

Disability Insurance

Paid Time Off from Day One

403-B Retirement Plan

Parental Leave - 4 Weeks

Career Development

Well-being Resources

Mental Health Resources

Pet Benefits

Job summary

AdventHealth is seeking a skilled Coding Auditor/Quality Reviewer to join our Revenue Cycle team in Florida. You will perform quality reviews of coded records for ICD-10, ICD-10-PCS, MS-DRG and APR-DRG accuracy, while educating staff on changes in the coding and reimbursement landscape.

You will interpret clinical documentation, request clarifications from physicians, and help write compelling DRG appeals to defend assignments and protect reimbursement.

Qualifications

• Proven knowledge of Medicare DRGs, APR-DRG, coding guidelines and reimbursement systems.
• Excellent interpersonal, verbal, and written communication skills; proficient in physician relations.
• Computer skills including Microsoft Office and Encoder software.
• Self-motivated and able to work independently in a remote setting.
• Critical thinking and problem-solving skills.

Responsibilities

• Performs quality reviews on coded records to validate ICD-10, ICD-10-PCS, MS-DRG, APR-DRGs, and overall coding accuracy retrospectively and concurrently.
• Provides continuing education to individual coders and the coding staff concerning changes in the coding and reimbursement system and any weaknesses identified during the coding validation reviews.
• Reviews, analyzes, and interprets clinical documentation, seeking clarification from the physician when discrepancies exist, and effectively communicates with physicians and allied health personnel.
• Assists with writing compelling appeals to all DRG denials from outside agencies, referencing Official Coding Guidelines and Coding Clinic advice as appropriate to defend the DRG assignment and protect the organization’s reimbursement.
• Serves as a resource to other departments in the Revenue Cycle to ensure business continuity and optimal revenue cycle management.

Skills

Critical thinking

Communication skills

Independent remote work

Education

High School Grad or Equiv

Technical/Vocational School

Tools

Microsoft Office

Encoder software

Job description

AdventHealth is seeking a skilled Coding Auditor/Quality Reviewer to join our Revenue Cycle team in Florida. You will perform quality reviews of coded records for ICD-10, ICD-10-PCS, MS-DRG and APR-DRG accuracy, while educating staff on changes in the coding and reimbursement landscape.

You will interpret clinical documentation, request clarifications from physicians, and help write compelling DRG appeals to defend assignments and protect reimbursement.