💻 The Role
The Clinical Coding Analyst plays a vital role in pre-bill inpatient chart reviews, focusing on MS DRG assignment. You'll identify revenue opportunities and compliance risks, ensuring accurate coding and reporting. This is a remote position, offering flexibility in your work schedule.
What You'll Do:
- Daily pre-bill chart reviews and communication with clients within a 24-hour timeframe.
- Report daily client volumes to the Audit Manager by 7 AM EST.
- Review electronic health records to pinpoint revenue opportunities and potential coding compliance issues using ICD-10-CM/PCS coding rules, AHA Coding Clinics, and clinical knowledge.
- Conduct verbal reviews of cases with potential MS DRG recommendations and/or physician query opportunities, collaborating with the company physicians via phone calls before submitting recommendations to the client.
- Ensure daily work lists are uploaded into the MS DRG Database and enter required data elements for each patient recommendation.
- Prepare and communicate recommendations (increased/decreased reimbursement, or FYI) to clients within 24 hours of review.
- Address client questions and rebuttals within 24 hours.
- Review and appeal Medicare and/or third-party denials on charts processed through the MS DRG Assurance program (if warranted).
- Review inclusions and exclusions related to 30-Day Readmissions and Mortality quality measures for traditional Medicare payers.
- Maintain IT access at assigned client sites.
- Stay updated on ICD-10-CM/PCS code changes, AHA Coding Clinics, and Medicare regulations.
- Utilize internal resources like TruCode, I10 Wiki, and CDocT.
- Adhere to all company policies and procedures.
🔎 What We're Looking For:
- Required: AHIMA credential of CCS, CDIP, or ACDIS credential of CCDS. AHIMA-approved ICD-10 CM/PCS Trainer certification is preferred.
- Preferred: Graduation from an accredited Health Information Technology or Administration program with AHIMA credential of RHIT or RHIA.
- Required: Minimum 7 years of acute inpatient hospital coding, auditing, and/or CDI experience in a large tertiary hospital.
- Preferred: Experience with CDI (Clinical Documentation Improvement) programs.
- Required: Extensive knowledge of ICD-10 CM/PCS.
- Required: Experience with electronic health records (Cerner, Meditech, Epic, etc.).
- Required: Experience working remotely.
- Required: Excellent oral and written communication skills.
- Required: Demonstrated analytical ability, initiative, and resourcefulness.
- Required: Ability to work independently.
- Required: Excellent planning and organizational skills.
- Required: Teamwork and flexibility.
- Required: Proficiency in Microsoft Office Word and Excel.
⏰ Schedule & Location:
You'll set your own work hours, but daily client volume reports are due by 7 AM EST. Our typical workday is 8 AM–5 PM EST/CST. You'll schedule daily meetings with the physician team (available 7:30 AM–6 PM EST). This is a fully remote position, open to candidates nationwide except those in CA, DC, MN, CO, HI, NJ, CT, IL, NV, DE, MA, or NY.
🏠 Home Office Requirements:
- High-speed internet connection.
- Dedicated, secure workspace to comply with HIPAA regulations.
- Company-provided laptop and resources.
🤝 Interview Process:
- Case Study Skills Assessment (PCS Coding and Clinical Validation)
- Audit Manager/Team Lead Meeting – Video Call (1 hour)
- Verbal Case Study Discussion – Video Call (1 hour)