Job description

Full-time | Remote | Permanent

Managed Resources is a leading consulting group assisting healthcare organizations nationwide in optimizing its revenue cycle management through review, recovery and educational programs. Please read the below description and apply if you meet the requirements and would like to hear more about this opportunity with Managed Resources!

The Lead DRG Appeals Coder works under the direction of the Clinical Appeals and CDI Manager. The Lead DRG Appeals Coder will perform quality assurance audits, assist in orientation and training of DRG Clinical Nurses/Coders, and assist in planning, implementation, and execution of department and organizational goals. The Lead DRG Appeals Coder will maintain regular job duties as a DRG Appeals Coder to include billable hours dependent on the business needs of the department.

Accountabilities:

Assist with monitoring the workflow of DRG denials staff.
Subject matter expert for DRG downgrade denials and CDI questions from team members.
Foster a collaborative and supportive team environment to optimize productivity and accuracy.

Essential Job Functions:

Complete the following functions in accordance with Managed Resources policies

Provides support to Clinical Appeals DRG staff and serves as a resource and subject matter expert.
Conduct quality reviews and assist in feedback to the Clinical Appeals DRG Nurse or Coder.
Monitors productivity and quality standards of the Clinical Appeals DRG Nurses and Coders.
Helps maintain Elenchus worklists (Pending Assignment, Pending Expert Review) and maintains personal work queue.
Assists with recruiting, interviewing, and training of employees.
Maintain job duties as a Clinical Appeals DRG Nurse or Coder (Appeal writer) with billable hours.
Develops and maintains strong working relationships with other leaders and provides cross coverage as needed.
Trouble shoots client access and other computer problems. Identifies problems and recommends solutions.
Provides feedback to Manager and Director on operational concerns and oversight of team members.
Exemplifies the core values.
Other duties as assigned.

Ideal candidate will possess the following:

Must hold the following credential: CPC, CCS, CCDS or CDIP, or RHIT Certification
5+ years of clinical experience in Hospital inpatient and outpatient departments
3+ years of clinical appeals/denials writing experience
Experience reviewing and analyzing denied/downgraded MS-DRG and APR-DRG and APC medical records and accounts received from payers (e.g., Medicare, Commercial, and Third Party)
Must have experience working in systems such as EPIC, Cerner, Next Gen, Allscripts or other EHR
Excellent verbal and written communication skills
Ability to interact with management personnel
Training experience
Possess strong organizational skills and attention to detail
Adaptive and flexible to new ideas and change
Ability to work in a changing environment
Participate in special projects as needed

Job Type: Full-time

Pay: $85,000.00 - $115,000.00 per year

Benefits:

401(k)
401(k) matching
Dental insurance
Health insurance
Life insurance
Paid time off
Vision insurance

Application Question(s):

Do you have experience with drafting/writing DRG downgrade/coding denial appeal letters?

Experience:

Inpatient coding: 5 years (Required)
Hospital experience: 5 years (Required)

License/Certification:

CCS, CDPIP, CCDS or RHIT (Required)

Work Location: Remote

Managed Resources, Inc (MRI) jobs

Senior Clinical DRG Appeals Nurse Specialist