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　　MO-REMOTE

　　Worker Type:

　　Regular

　　Job Summary:

　　Ensures responsibility for the diagnostic related group ambulatory payment classification (DRG/APC) denial and appeal management process. Preforms the necessary coding and documentation validation to respond to payor denials.

　　Job Responsibilities and Requirements:

　　Job Description

　　PRIMARY RESPONSIBILITIES

　　Composes DRG/APC appeals based on medical record documentation, coding guidelines and Coding Clinic for denials and/or adjustments.

　　Identifies, analyzes, and researches frequent root causes of denials and develops reporting tools that effectively measure and monitor in order to support process improvement for coding, contracting, and clinical documentation teams.

　　Maintains denial/appeal process in collaboration with other revenue cycle stakeholders.

　　Identifies and communicates denial trends in order to positively affect the volume of denials.

　　Reviews and assists with internal and external coding and charging audits as applicable.

　　Assists with coding education as applicable.

　　Performs other duties as assigned.

　　EDUCATION

　　Associate's degree in health information or related field, or equivalent years of experience and educationEXPERIENCE

　　Three years' experiencePHYSICAL REQUIREMENTS

　　Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.

　　Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.

　　Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.

　　Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.

　　Frequent keyboard use/data entry.

　　Occasional bending, stooping, kneeling, squatting, twisting and gripping.

　　Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.

　　Rare climbing.

　　Licenses / Certifications:

　　Certified Coding Associate (CCA) - American Health Information Management Assoc (AHIMA), Certified Coding Specialist (CCS) - American Health Information Management Assoc (AHIMA), Certified Professional Coder (CPC®) - American Academy of Professional Coders (AAPC), Registered Health Information Administrator (RHIA) - American Health Information Management Assoc (AHIMA), Registered Health Information Technician (RHIT) - American Health Information Management Assoc (AHIMA)

　　Work Shift:

　　Day Shift (United States of America)

　　Job Type:

　　Employee

　　Department:

　　8701390033 Pre-Service

　　Scheduled Weekly Hours:

　　40

　　SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status , or any other characteristic protected by applicable law. Click here to learn more. (https://www.ssmhealth.com/privacy-notices-terms-of-use/non-discrimination?_ga=2.205881493.704955970.1667719643-240470506.1667719643)