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Clinical Documentation Specialist - DRG Appeals

Clinical Documentation Specialist - DRG Appeals

catholic healthMelville, NY

11 days ago

$170,000.00 /Yr

Health Information Technologists and Medical RegistrarsMedical Records SpecialistsHealthcare Diagnosing or Treating Practitioners, All Other
General Medical and Surgical HospitalsOffices of Physicians (except Mental Health Specialists)All Other Miscellaneous Ambulatory Health Care Services
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Job Title Conducts timely DRG Appeals supporting the CHS DRG Appeals Shared Service.
Job Description: Analyzes denials and appeals cases as appropriate. Determines accuracy of coding based upon review of the medical documentation and application of the coding guidelines. Clinically validates diagnoses in question. Manages the complete appeals process through all levels of appeal according to payor contract.
Duties/Responsibilities:
  • Initiate and follow through for all RAC and Third Party Payor denials at every level, reviews all denials with direct report for plan/strategy for appeal.
  • Must be able to meet or exceed appeal deadline completion times.
  • Involve appropriate physicians in the appeal process expanding into the preparation for ALJ and DRA.Follow up Third Party Payor responses to all appeals as appropriate and update RAC and Third Party Payor focus studies, as well as Epic revenue cycle with attention to detail.
  • Communicate denial issues with site HIM/CDIP Department and patient accounts.
  • Continuously evaluates the quality of clinical documentation to identify incomplete or inconsistent documentation, clinical validation for inpatient diagnoses that impact the code selection, resulting DRG, and payment.
  • Working knowledge of AHA Coding Clinics
  • Working knowledge of encoder, ability to correct coding and re-drop bill.
  • Communicates with physician advisor, or attending physician verbally or through written methodology to validate diagnosis in question and support appeal.
  • Provides feedback to HIM management staff and CDI leadership regarding opportunities for documentation improvement, and participates with the planning and development of educational programs directed towards improving documentation.
  • Participates in education programs to maintain up to date coding skills.
  • Position Requirements and Qualifications
Education: Bachelors of Science in Nursing, ORNP or PA license.
Licensure/Certification: Current NYS License.
Certification: CCDS required
Skills: Proficient computer skills for Windows Microsoft Office Applications (Word, Excel, Power Point) Self-motivated, self-directed, and able to work independently with minimal supervision.
Experience:
  • Five years clinical experience in Acute Hospital setting. Minimum of 2 years inpatient CDI experience. Proficiency in ICD-10-CM and PCS Official Guidelines for Coding and Reporting
  • Other: Multitasking, excellent communication and critical thinking skills.
  • Posted Salary RangeUSD $130,000.00 - USD $170,000.00 /Yr.
This range serves as a good faith estimate and actual pay will encompass a number of factors, including a candidate's qualifications, skills, competencies and experience. The salary range or rate listed does not include any bonuses/incentive, or other forms of compensation that may be applicable to this job and it does not include the value of benefits. At Catholic Health, we believe in a people-first approach. In addition to the estimated base pay provided, Catholic Health offers generous benefits packages, generous tuition assistance, a defined benefit pension plan, and a culture that supports professional and educational growth.

Also on the board Same function, level within a rung

Level

Senior

Salary

$170,000.00 /Yr

Location

Melville, NY

Occupation

Health Information Technologists and Medical Registrars

Industry

General Medical and Surgical Hospitals

Posted

11 days ago

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