Clinical Coding Analyst

Job Description

Job Description

Description :

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.

About Us

At Brundage Group, we believe hospitals are a vital part of our communities. Our team is passionate about improving the health of our hospital clients through our advisory, analytics and staffing solutions. We aim to be an essential partner to our hospital clients in optimizing their clinical revenue cycle operations and outcomes, so they can continue to serve our communities.

Requirements :

• Monitors and manages DRG review and DRG denials work queues to ensure timely completion of deliverables within company standards.
• Review DRG-related claim denials and downgrades.
• Analyze medical records and denial explanations to determine appeal viability.
• Draft detailed and evidence-based appeal letters citing clinical guidelines, coding standards (ICD-10, CPT, MS-DRG), and payer policies.
• 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.

KNOWLEDGE, SKILLS, AND ABILITIES : Abilities may be accessed through written, verbal, and other evaluation methods.

WORK EXPERIENCE, EDUCATION AND CERTIFICATIONS :

WORKING CONDITIONS AND PHYSICAL REQUIREMENTS :

Conditions typically associated with an office environment. While performing the essential duties and

responsibilities, the employee is regularly required to talk or hear. May be frequently required to sit, stand or

walk. Moderate to prolonged reading, typing, and computer work. Ability to perform tasks involving physical

activity that may include lifting to 25 pounds. Subject to exposure to all environmental hazards associated with

healthcare and office work.