Coding/CDI Denials Analyst - CCDS
About the position The Coding/CDI Denials Analyst primary responsibilities are to review coding denials for inpatient hospital medical records, for accuracy of assigned codes, and ensure all Official Coding Guidelines and conventions were followed. Also, to ensure the clinical evidence and provider documentation supports the assigned codes and DRG. Compose and submit appeal letters as appropriate, identify coding trends/opportunities for root causes of denials, which would be relevant for additional education to individual Coders/CDI Specialist's and/or the entire Coding/CDI Teams. Report these trends/opportunities to the Lead Denials Analyst to ensure education is developed and provided to the Coders and/or CDI Teams. Identify and communicate front-end activities that influence the denials/appeals process, seeking opportunities for process improvement.
Responsibilities
- Review coding denials for inpatient hospital medical records, for accuracy of assigned codes, and ensure all Official Coding Guidelines and conventions were followed.
- Ensure the clinical evidence and provider documentation supports the assigned codes and DRG.
- Compose and submit appeal letters as appropriate.
- Identify coding trends/opportunities for root causes of denials, which would be relevant for additional education to individual Coders/CDI Specialist's and/or the entire Coding/CDI Teams.
- Report these trends/opportunities to the Lead Denials Analyst to ensure education is developed and provided to the Coders and/or CDI Teams.
- Identify and communicate front-end activities that influence the denials/appeals process, seeking opportunities for process improvement.
- Review coding and/or clinical denials, ensuring all coding guidelines and conventions were followed, and ensuring all clinical evidence and provider documentation supports the assigned codes and DRG.
- Compose an effective appeal utilizing appropriate coding guidelines, relevant and effective clinical documentation, current industry guidelines, evidence-based medicine, and local and national medical management standards and protocols.
- Identify coding and/or documentation trends for root causes of denials.
- Identify and communicate DRG changes and financial impact.
- Identify coding and clinical educational opportunities and report these to the Lead Denials Analyst.
- Identify front-end activities that influence denial/appeals process.
- Support the Quality Standards set by UTSW and the HIM Coding & CDI Department.
- Maintains an expert level of knowledge of Coding/CDI guidelines and practices.
- Other duties as assigned.
Requirements
- 3 years three to five (3-5) year's acute hospital-based Coding and/or CDI experience or An equivalent combination of education and experience may be considered
- Denials and Appeals experience in an acute Hospital setting
- Experience working in a remote environment
- (RHIA) REGD HEALTH INFO ADMINIST or (RHIT) REGD HEALTH INFO TECHNOLO or (CCS) CERT CODING SPECIALIST or (CCDS) Cert Clinical Documentation or (CDIP) CERT DOCUMNTATN IMPROVMNT PRAC
Nice-to-haves
- RN with CDI experience
Benefits
- PPO medical plan, available day one at no cost for full-time employee-only coverage
- 100%25 coverage for preventive healthcare-no copay
- Paid Time Off, available day one
- Retirement Programs through the Teacher Retirement System of Texas (TRS)
- Paid Parental Leave Benefit
- Wellness programs
- Tuition Reimbursement
- Public Service Loan Forgiveness (PSLF) Qualified Employer