Under the direction of the DRG Supervisor or designee, this role performs retrospective medical claims review for coding and pricing determinations, including inpatient facility coding review, diagnosis and procedural coding, and DRG validation.
The position serves as a subject matter expert on medical claims coding for outpatient and inpatient services, supports clinical and non-clinical staff, develops determination letters, and provides coding-related guidance to medical directors, providers, peer reviewers, Claims Administration, Program Integrity, Quality Management, and subcontractors as needed.
This is a remote position with work-from-home eligibility in approved states only.
Required
- High school diploma or GED
- Current CIC, CCS, or RHIT certification
- U.S. citizenship
- Ability to obtain a favorable interim and final Department of Defense background investigation
- Minimum 5 years of clinical coding experience for facility and/or professional accounts
- Minimum 3 years of claims processing experience for inpatient and/or outpatient accounts
- Experience in a fast-paced environment
Preferred
- Experience in the private medical industry, health insurance, or managed care
- Familiarity with TRICARE and the military healthcare delivery system
Key skills
- Advanced knowledge of ICD-10-CM, ICD-10-PCS, CPT, and HCPCS coding
- Advanced knowledge of inpatient facility coding and DRG validation
- Advanced knowledge of utilization review processes and/or claims processing
- Proficiency with Word and Excel
- Strong communication, analysis, organization, and independent problem-solving skills
Benefits
- Medical, dental, and vision coverage
- Paid time off
- 401(k) retirement savings plan with matching
- Short-term and long-term disability insurance
- Basic life and accidental death and dismemberment insurance
- Tuition reimbursement
- Paid volunteer time
- Overtime opportunities
- Frequent pay raises
- Recognition and reward programs
Location
Phoenix, Arizona, US
Employment Type
Full-time
Experience Level
Senior
Salary Range
$80,000 - $84,000
Remote work allowed
Yes
Posted
1 week ago