Clinical Coding Analyst

The Clinical Coding Analyst will collaborate directly with the Physician Advisor.

The Clinical Coding Analyst is a credentialed coder, HIM professional or Registered Nurse with significant experience performing DRG audits and/or appeals. The Clinical Coding Analyst will perform inpatient chart reviews to identify coding opportunities that may impact DRG assignment or draft letters to appeal payor DRG denials. Each day may include a mix of these activities or may primarily focus on one or the other activities depending on case volumes.

DRGs review include identification of revenue opportunities as well as coding and compliance risks. The appeals process includes reviewing the payor denial and authoring appeal letters when appropriate. The analyst should have expert knowledge of the Official ICD 10-CM/PCS Guidelines for Coding and Reporting and AHA Coding Clinics. In addition to strong coding knowledge, the Clinical Coding Analyst must be able to concisely articulate compelling, well-written, professional arguments to refute the payor’s assertion. 

Responsibilities

•  Monitors and manages DRG review and DRG denials work queues to ensure timely completion of deliverables within company standards.
• Perform chart reviews to identify coding opportunities, documentation opportunities, potential coding compliance issues, or assess if there is sufficient evidence to refute payor denials.
• Perform validation reviews with the supervising Physician Advisor for all reviewed records.
• Collaborate with a Physician Advisor on authored appeals.
• Perform all chart reviews within 2 business days of receipt of case.
• Provide input and recommendations to Brundage Group management for process improvement.
• Demonstrate the ability to use proper grammar and punctuation when constructing written communication that clearly identifies the issue when performing DRG audits or refutes the payor’s findings when authoring an appeal.
• Ensure all client deliverables are professional and properly formatted using Brundage Group templates with company fonts, colors, etc.
• Maintain IT access to client sites and know how to escalate IT issues that can negatively impact the ability to perform assigned duties to avoid downtime.
• Maintain HIPAA and all other privacy compliance standards as required by Federal law, State law or Brundage Group. • Maintain relevant credentials required for the role e.g., RN, RHIA, RHIT, CCS, CDIP, CCDS, etc. as well as current knowledge of AHA coding clinic and ICD-10-CM/PCS code changes.
• Participation in client calls to support the client relationship and company meetings as needed.
• Work collaboratively with operations, client engagement and the supervising physician advisor to ensure cases are received in a timely manner and processed accordingly to meet deadlines.
• Responsibility for other duties as assigned or requested. 

Qualifications

• Credentials: a combination of any of the following: CCS, CDIP, CCDS, RHIT, RHIA,RN 
• High level coding expertise Clinical Coding Analyst Job Description
• At least 5 years of recent inpatient coding experience or MS-DRG auditing experience and at least 2 years’ experience in denials management and authoring appeal letters.
• Strong computer skills.
• Consulting experience preferred.
• Experience with CDI or as a second level reviewer preferred.
• Must have strong oral and written communication skills.
• Ability to work independently in a remote environment and collaborate well with other departments. 
• Willingness and ability to travel