UCI Health
DRG Appeals Specialist - Health Information - FT Days
UCI Health, Orange, California, United States, 92613
Overview
UCI Health, the academic health system of the University of California, Irvine, is seeking a DRG Appeals Specialist. The role reviews denied or downgraded MS-DRG and APR-DRG accounts, determines appealability, prepares appeal letters, and tracks denial root causes to identify coding improvement opportunities. Responsibilities
Review and analyze denied or downgraded MS-DRG and APR-DRG accounts from payers including Medicare, Commercial, and Third-Party. Determine if a denied or downgraded account is appealable using coding expertise and current coding guidelines. Prepare appeal letters based on clinical criteria, coding guidelines, and payer processes. Track and trend denial root causes to identify documentation and coding improvement opportunities. Qualifications
Previous experience reviewing and processing appeals. Knowledge of MS-DRG and APR-DRG structures, payment methodology, and payer appeal processes. Understanding of AHA official coding guidelines, anatomy, physiology, disease process, medical terminology, and ICD-10 coding conventions. Excellent written and verbal communication and organizational skills. Electronic Health Record experience (3M, Epic, CCS credential). Five years inpatient coding experience required. Preferred Qualifications
Working knowledge of Clinical Documentation Improvement and prior denial management experience. Prior EPIC experience and coding experience in an acute care academic setting. Compensation and Benefits
UCI Health offers a comprehensive benefits package including medical insurance, sick and vacation time, retirement savings plans, and access to discounts and perks. For more information, visit UCI Health benefits practices. Conditions of Employment
UCI Health provides a safe and healthy environment. Applicants must comply with background checks, live scan, employment misconduct disclosure, legal right to work, vaccination policies, smoking and tobacco policy, and drug-free environment. California child abuse and neglect reporting act, E-Verify, pre-placement health evaluation policies apply. For more details, visit
UCI Conditions of Employment . Equal Opportunity Employment
UCI Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity, national origin, disability, age, veteran status, or other protected categories covered by the UC Anti-Discrimination Policy. UCI provides reasonable accommodations for applicants with disabilities upon request. Contact UCI Employee Experience Center at eec@uci.edu or (949) 824-0500 Monday – Friday 8:30 a.m. – 5:00 p.m. Work authorization sponsorship is required; proof of work authorization must be provided.
#J-18808-Ljbffr
UCI Health, the academic health system of the University of California, Irvine, is seeking a DRG Appeals Specialist. The role reviews denied or downgraded MS-DRG and APR-DRG accounts, determines appealability, prepares appeal letters, and tracks denial root causes to identify coding improvement opportunities. Responsibilities
Review and analyze denied or downgraded MS-DRG and APR-DRG accounts from payers including Medicare, Commercial, and Third-Party. Determine if a denied or downgraded account is appealable using coding expertise and current coding guidelines. Prepare appeal letters based on clinical criteria, coding guidelines, and payer processes. Track and trend denial root causes to identify documentation and coding improvement opportunities. Qualifications
Previous experience reviewing and processing appeals. Knowledge of MS-DRG and APR-DRG structures, payment methodology, and payer appeal processes. Understanding of AHA official coding guidelines, anatomy, physiology, disease process, medical terminology, and ICD-10 coding conventions. Excellent written and verbal communication and organizational skills. Electronic Health Record experience (3M, Epic, CCS credential). Five years inpatient coding experience required. Preferred Qualifications
Working knowledge of Clinical Documentation Improvement and prior denial management experience. Prior EPIC experience and coding experience in an acute care academic setting. Compensation and Benefits
UCI Health offers a comprehensive benefits package including medical insurance, sick and vacation time, retirement savings plans, and access to discounts and perks. For more information, visit UCI Health benefits practices. Conditions of Employment
UCI Health provides a safe and healthy environment. Applicants must comply with background checks, live scan, employment misconduct disclosure, legal right to work, vaccination policies, smoking and tobacco policy, and drug-free environment. California child abuse and neglect reporting act, E-Verify, pre-placement health evaluation policies apply. For more details, visit
UCI Conditions of Employment . Equal Opportunity Employment
UCI Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity, national origin, disability, age, veteran status, or other protected categories covered by the UC Anti-Discrimination Policy. UCI provides reasonable accommodations for applicants with disabilities upon request. Contact UCI Employee Experience Center at eec@uci.edu or (949) 824-0500 Monday – Friday 8:30 a.m. – 5:00 p.m. Work authorization sponsorship is required; proof of work authorization must be provided.
#J-18808-Ljbffr