University of Rochester DRG Coding Denial Analyst in Rochester, New York
Full Time 40 hours Grade 010 Utilization Management
8 AM-4:30 PM
The DRG Coding Denial Analyst establishes, monitors and coordinates the identification, investigation and resolution of provider DRG denials and grievances in accordance with state and federal regulations and guidelines for SMH and affiliates. Point of contact for coding inquires, education and DRG denial trends between HIM, UM, PFS and Compliance departments.
Associates degree in Health Information Technology or Bachelors in Health Information Administration preferred with three years coding in an acute care facility in a training/detailed project role; or equivalent combination of education and experience. Successful completion of American Health Information Management Association (AHIMA) accreditation examination for Registered Health Information Administrator (RHIA) or (Registered Health Information Technician) RHIT or Certified Coding Specialist (CCS) preferred. Knowledge of ICD-9CM and ICD-10CM required.
Experience in appeals with extensive and in-depth knowledge of ICD-9 and ICD-10 diagnosis and procedure coding classifications including coding conventions and guidelines, Diagnosis Related Groups, and reimbursement methodology.
Comprehensive understanding of anatomy and medical terminology, excellent vocabulary, grammar, spelling, punctuation and composition skills for effective written and verbal communication. Prioritization and organizational skill to effectively manage competing priorities and multiple deadlines.
Knowledge of regulatory requirements of government and third party payers relating to coding and prospective payment and HIPAA laws. Proficiency in Microsoft Office, 3M/HDM, UDS/Clintegrity, Flowcast and eRecord.
EOE Minorities/Females/Protected Veterans/Disabled
Job Title: DRG Coding Denial Analyst
Location: Strong Memorial Hospital
Job ID: 208978
Full/Part Time: Full-Time