Deskripsi Pekerjaan
Join Sales Rain BPO Inc. as an Inpatient Coding Appeals Specialist and play a critical role in ensuring accurate healthcare reimbursement through meticulous medical record review. You'll validate principal diagnoses, secondary diagnoses (CC/MCC), procedures, and DRG assignments to optimize revenue cycle outcomes. This position requires deep expertise in coding guidelines, compliance standards, and appeals processes to resolve discrepancies and support healthcare providers in maximizing rightful reimbursements. Collaborate with multidisciplinary teams to analyze complex medical documentation, identify coding errors, and develop compelling appeals submissions. Your expertise will directly impact financial outcomes while maintaining regulatory compliance and operational excellence.
Tanggung Jawab
- Review inpatient medical records to validate accuracy of principal diagnosis, secondary diagnoses (CC/MCC), and procedures
- Analyze DRG assignments to ensure optimal reimbursement and compliance with regulatory standards
- Identify coding discrepancies and prepare comprehensive documentation for appeals submissions
- Collaborate with physicians and coding specialists to resolve complex documentation issues
- Stay updated on ICD-10-CM, CPT, and HCPCS coding guidelines and regulatory changes
- Develop and submit compelling appeals for denied claims based on coding inaccuracies
- Maintain detailed records of coding decisions and appeal outcomes for audit purposes
Kualifikasi
- Bachelor's degree in Health Information Management, Nursing, or related healthcare field
- Certified Inpatient Coder (CIC) or equivalent credential preferred
- Minimum 3 years of experience in inpatient coding and DRG assignment
- Proficiency in ICD-10-CM, CPT, and HCPCS coding systems
- Strong knowledge of medical terminology, anatomy, and physiology
- Experience with electronic health records (EHR) and coding software (3M, Encoder, etc.)
- Excellent analytical skills with attention to detail in documentation review
- Ability to interpret complex medical records and coding guidelines accurately