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Community Health Systems · 1 month ago

DRG Denials Auditor

United States

Full-time

Remote

Mid Level

3+ years exp

Community Health Systems is seeking a DRG Denials Auditor to conduct hospital inpatient DRG denial audits for both RAC and non-RAC accounts. The role involves reviewing patient records for coding accuracy, writing appeal letters to payers, and providing audit feedback to improve coding practices.

Health CareHospital

Responsibilities

Performs inpatient denial reviews using ICD-10-CM/PCS and DRG validation utilizing appropriate coding references for CHS hospitals via scanned, electronic and hybrid medical records. Based on review findings, writes appeal letters to include supporting documentation

Utilizes hospital abstracting system for coding validation when applicable with access to the 3M encoder

Captures detailed data on reason for the denial and appeal status

Consults with Coordinator and/or Director, Coding Denials and Appeals during any audit discrepancies

Attends coding education to include regulatory change updates and changes affecting coding rules and/or DRG assignments

Maintains productivity levels set forth by the HIIM Department and interdepartmental policy with periodic quality monitoring and evaluation of work products by the Coordinator and/or Director, Coding Denials and Appeals

Partners with peers and Director to develop coder education based on findings

Performs other duties as assigned

Complies with all policies and standards

Qualification

ICD-10-CM/PCS codingDRG validationCoding audit experienceClinical Documentation ImprovementElectronic medical record systemsMedical terminologyCertified Coding SpecialistCommunication skillsOrganizational skillsAttention to detail