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CodingAID a division of Managed Resources
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CLINICAL DRG APPEALS LEAD

Remote US

2024-10-15 2024-12-13 Industry: Coder - CDI Job Number: 3023


JOB DESCRIPTION


The Lead Clinical Coding Appeals Coder works under the direction of the Clinical
Appeals and CDI Manager. The Lead DRG Appeals Coder will perform quality
assurance audits, assist in orientation and training of DRG Clinical
Nurses/Coders, and assist in planning, implementation, and execution of
department and organizational goals. The Lead DRG Appeals Coder will maintain
regular job duties as a DRG Appeals Coder to include billable hours dependent on
the business needs of the department.

Reports to:                   

Manager of Clinical Appeals- DRG and CDI

Accountabilities:

 * 
   Assist with monitoring the workflow of DRG denials staff.
   
 * 
   Subject matter expert for DRG downgrade denials and CDI questions from team
   members.
   
 * 
   Foster a collaborative and supportive team environment to optimize
   productivity and accuracy.
   


Essential Job Functions:

Complete the following functions in accordance with Managed Resources policies

 * 
   Provides support to Clinical Appeals DRG staff and serves as a resource and
   subject matter expert.
   
 * 
   Conduct quality reviews and assist in feedback to the Clinical Appeals DRG
   Nurse or Coder.
   
 * 
   Monitors productivity and quality standards of the Clinical Appeals DRG
   Nurses and Coders.
   
 * 
   Helps maintain Elenchus worklists (Pending Assignment, Pending Expert Review)
   and maintains personal work queue.
   
 * 
   Assists with recruiting, interviewing, and training of employees.
   
 * 
   Maintain job duties as a Clinical Appeals DRG Nurse or Coder (Appeal writer)
   with billable hours.
   
 * 
   Develops and maintains strong working relationships with other leaders and
   provides cross coverage as needed.
   
 * 
   Trouble shoots client access and other computer problems. Identifies problems
   and recommends solutions.
   
 * 
   Provides feedback to Manager and Director on operational concerns and
   oversight of team members.
   
 * 
   Exemplifies the core values.
   
 * 
   Other duties as assigned.
   


Ideal candidate will possess the following:

 * 
   Must hold the following credential: CPC, CCS, CCDS or CDIP, or RHIT
   Certification
   
 * 
   5+ years of clinical experience in Hospital inpatient and outpatient
   departments
   
 * 
   3+ years of clinical appeals/denials writing experience
   
 * 
   Experience reviewing and analyzing denied/downgraded MS-DRG and APR-DRG and
   APC medical records and accounts received from payers (e.g., Medicare,
   Commercial, and Third Party)
   
 * 
   Must have experience working in systems such as EPIC, Cerner, Next Gen,
   Allscripts or other EHR
   
 * 
   Excellent verbal and written communication skills
   
 * 
   Ability to interact with management personnel
   
 * 
   Training experience
   
 * 
   Possess strong organizational skills and attention to detail
   
 * 
   Adaptive and flexible to new ideas and change
   
 * 
   Ability to work in a changing environment
   
 * 
   Participate in special projects as needed
   


Check Out Our Benefits:

 * 
   401(k)
   
 * 
   401(k) matching
   
 * 
   Dental insurance
   
 * 
   Disability insurance
   
 * 
   Employee assistance program
   
 * 
   Flexible spending account
   
 * 
   Health insurance
   
 * 
   Life insurance
   
 * 
   Paid time off
   
 * 
   Referral program
   
 * 
   Vision insurance
   
 * 
   Pet Insurance
   
 * 
   Monthly Internet Stipend
   


 

Pay: $85,000.00 - $115,000.00 per year

Managed Resources is an Equal Opportunity Employer (EOE) M/F/D/V/SO

Our Vision: To become the most trusted, innovative and consultative revenue
cycle partner in the nation.

Visit http://jobs.managedresourcesinc.com to find more jobs and sign up for job
alerts.



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