As a Clinical Coding Appeals Author , you will help review and interpret medical records to draft appeals of denied and underpaid claims. Every day you will, review medical records to ensure appropriate coding of removed or revised diagnosis and procedure codes. Then you will draft appeal letters based on clinical judgment and knowledge and making coding change suggestions to our clients based on ICD-9/10 CM & PCS, CPT, HCPCS, NCCI guidance, and Coding Clinic. To thrive in this role, you must able to identify different types of hospital documentation including, but not limited to, medical records, UB-04s, EOBs, itemized bills, hospital account notes, appeal letters, and denial/approval letters.
Responsibilities:
Review and interpret medical records to appeal denied and underpaid claims
Apply clinical judgment and knowledge for DRG downgrades performed as a result of a Clinical Validation Review by an insurer or third-party auditor
Draft appeal letters that are well written, logically structured, and persuasive, utilizing ICD-9/10 CM & PCS, CPT, HCPCS, NCCI guidance, and Coding Clinic
Handle rush and high balance cases in accordance with office policy for prioritization
Ensure that all appeals are completed timely and sent by the specified deadline
Required Qualifications:
Active RN or PA license
Active AHIMA or AAPC Coding Certification including CCS, RHIA, RHIT, CCA, CPC-A, CPC-H (COC), CPMA, CIC, CDI or CDIP
2+ years of experience in medical record reviews/audits
Knowledge of, or experience in working with the verbal and written appeals process
Must have experience with electronic medical record systems
Knowledge of HIPAA laws and requirements required
Must be able to communicate effectively and professionally with strong attention to details and problem solving both verbally and written
Desired Qualifications:
Inpatient, outpatient and/or DRG auditing preferred
Ability to operate common computer systems
Intermediate skill level of Microsoft Word, Excel, PowerPoint and Outlook
For this US-based position, the base pay range is $67,061.41 - $106,374.00 per year . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.
The healthcare system is always evolving - and it's up to us to use our shared expertise to find new solutions that can keep up. On our growing team you'll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career.
Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team - including offering a competitive benefits package. (http://go.r1rcm.com/benefits)
R1 RCM Inc. ("the Company") is dedicated to the fundamentals of equal employment opportunity. The Company's employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person's age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.
If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.
CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights California Consent (https://f.hubspotusercontent20.net/hubfs/4941928/California%20Consent%20Notice.pdf)
To learn more, visit: R1RCM.com
Visit us on Facebook (https://www.facebook.com/R1RCM)
#LI-AC01 #TJ2023
R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry's most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation and workflow orchestration.
Headquartered near Salt Lake City, Utah, R1 employs over 29,000 people globally and is traded on the Nasdaq stock exchange under the symbol "RCM."