Performs quality reviews on coded records to validate ICD-10, ICD-10-PCS, MS-DRG, and APR-DRG coding accuracy on both retrospective and concurrent reviews.
Provides education to coders and coding staff on coding and reimbursement changes, as well as issues identified during validation reviews.
Reviews and interprets clinical documentation, seeks physician clarification when needed, and communicates with physicians and allied health personnel.
Assists with writing appeals for DRG denials using Official Coding Guidelines and Coding Clinic guidance to defend DRG assignments and protect reimbursement.
Serves as a resource to Revenue Cycle departments to support business continuity and revenue cycle management.
Uses critical thinking and sound judgment to balance reimbursement considerations with regulatory compliance.
Prepares statistical reports on individual and overall coding accuracy.
Maintains confidentiality and works to meet turnaround time, productivity, and coding accuracy expectations.
Required skills and knowledge
- Strong inpatient coding skills
- Understanding of code edits
- Experience with Epic preferred
- Optum experience preferred
- Expansive knowledge of Medicare DRGs, APR-DRGs, coding guidelines, and reimbursement systems
- Excellent interpersonal, verbal, and written communication skills
- Strong physician relations skills
- Proficiency with Microsoft Office and encoder software
- Ability to work independently in a remote setting
- Critical thinking and problem-solving skills
- Strong organizational and prioritization skills with little supervision
- Knowledge of risk adjustment and publicly reported hospital data
- Understanding of patient safety indicators, SOI/ROM, value-based purchasing, and how coding impacts these measures
- Exhaustive knowledge of inpatient coding and ICD-10-CM, ICD-10-PCS, MS-DRGs, APR-DRGs, HACs, POA indicators, CMI, and regulatory compliance requirements
- Excellent computer skills, including Excel
Education
- High school diploma or equivalent required
- Technical/vocational school preferred
Experience
- 5+ years of inpatient or outpatient coding or auditing experience required
Licensure or certification
- RHIA, RHIT, CCS, or CPC required
Benefits and perks
- Medical, dental, and vision insurance from day one
- Life insurance
- Disability insurance
- Paid time off from day one
- 403(b) retirement plan
- 4 weeks of 100% paid parental leave
- Career development
- Whole person well-being resources
- Mental health resources and support
- Pet benefits
Location
Orlando, Florida, US
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
Yes
Posted
1 week ago