Remote - Clinical Denials & Appeals Auditor
Job Description & Requirements
Remote - Clinical Denials & Appeals Auditor
StartDate: 12/16/2024
Pay Rate: $50.00 - $60.00
Remote - Clinical Denials & Appeals Auditor
EDUCATION: CDIP or CCDS required and RN Preferred. CCS, RHIA or RHIT preferred. CPC and CPMA (Certified Professional Medical Auditor) is a plus.
EXPERIENCE:
A minimum of three –five years ongoing inpatient CDI and coding and abstracting experience in ICD-9-CM, ICD-10-CM/PCS and DRGs. 3-4 year's Clinical Documentation high level review experience required, with experience in mortality risk, PSI, medical necessity HAC's. A minimum of two years auditing experience.
SYSTEMS: 100% 3M 360 CAC & Encoder; Cerner, eCharms, Legacy, Medhost abstracting, (HMS)
SUMMARY:
Performs inpatient coding DRG denial audits of RAC and non-RAC payer accounts, for the HIIM Department at the Corporate office. Reviews patient records for accuracy in ICD-9-CM coding, ICD-10-CM/PCS, DRG assignment, present on admission indicators (POA), discharge disposition and any other pertinent data needed to capture coding accuracy. Provides audit feedback via the auditing process to pertinent parties, i.e. HIM Director, Corporate Coding Manager, etc.. Assists in preparation of the monthly and quarterly denials audit reports. Applied knowledge of medical terminology, pathophysiology, and pharmacology. Demonstrates tested data quality and integrity skills.
ESSENTIAL DUTIES:
Performs inpatient coding denial review using ICD-9-CM, ICD-10-CM/PCS, DRG validation (3Mcoding software) utilizing appropriate coding references for CHS hospitals via scanned, electronic and hybrid medical records.
Will utilize hospital abstracting system for coding validation when applicable.
Prepares preliminary results for review by the requesting party.
Reviews DRG change disagreements with the Director, Coding Denials and Appeals.
Assists in preparation of the final quarterly audit reports for Division VPs, AVPs, facility CEOs, CFOs, Regional HIM Directors, VP of HIIM.
Provides coder education via email and phone on all audits and uses applicable coding references.
Maintains productivity levels set forth by the HIIM Department and interdepartmental policy while maintaining a 97% accuracy rate by third party auditors.
Consults with Director, Coding Denials and Appeals during any audit discrepancies.
Attends coding workshops as necessary to maintain coding credentials.
Keeps abreast of regulatory changes affecting coding rules and regulations.
Maintains proficiency in the Official Coding Guidelines for coding and reporting and the AHA Coding Clinics.
Other duties as assigned by Director, Coding Denials and Appeals
JOB SKILLS:
Thorough knowledge of the related inpatient prospective payment systems (IPPS)
Experience in working DRG coding denials and writing appeal letters to government and non-government payers
Experience preserving coding integrity based on Coding Guidelines, Coding Clinic and appropriate coding references and resources
Broad knowledge of pharmacology indications for drug usage and related adverse reactions
Knowledge of anatomy, physiology and medical terminology
Understanding of coding practices and official guidelines
Experience with PC, mainframe applications, and encoding systems
Auditing skills for coding quality and compliance
Strong process management skills
Facility Location
Franklin, close neighbor to the much larger Nashville, is a livable city with a lovely historic downtown. The city's Main Street bustles with thriving small businesses and eateries, offering visitors and residents no shortage of entertainment options. The Franklin Theatre, established in 1937, is a cultural icon, boasting an ever-impressive roster of regional and national touring musicians, and showing classic movies on a weekly basis. Two annual Main Street Festivals reinforce the vibrant identity of the city and Pumpkinfest is a resident favorite, welcoming in autumn in style.
Job Benefits
Becoming an AMN Healthcare professional gives you the incredible opportunity to gain critical career experience, work with new people, and earn a highly competitive salary—but the perks don't stop there. There are many additional benefits to enjoy, including:
- Medical, dental and vision benefits
- Earned time off and paid holidays
- Paid continuing education time
- 401(K) retirement planning
- Short-term disability, life insurance, paid jury duty
- Access to the largest network of facilities and providers in the country
- Industry experienced workforce management team
- Licensure and certification reimbursement
About the Company
At AMN Healthcare, we strive to be recognized as the most trusted, innovative, and influential force in helping healthcare organizations provide quality patient care that continually evolves to make healthcare more human, more effective, and more achievable.