Skip to main content
Corporate Functions & Operations WellCare - Coding & Records Careers

Medical Coding Specialist Job

Full Job Title: DRG Medical Coding Specialist

Job Number: 1702171

Location: Tampa, FL

Date Posted: 5-10-2017

Performs post-payment review for Diagnosis Related Group (DRG) validation on inpatient medical records using International Classification of Diseases, Tenth Revision (ICD-10-CM) and Procedural Coding System (ICD-10-PCS) to identify incorrect coding.

Essential Functions:
  • Reviews and analyzes inpatient hospital medical records using International Classification of Diseases, Tenth Revision (ICD-10-CM) and Procedural Coding System (ICD-10-PCS). Always coding to the highest level of specificity.
  • Follows the Official ICD-10-CM Guidelines for Coding and Reporting and the ICD-10-PCS Official Guidelines for Coding and Reporting and has a complete understanding of these guidelines.
  • Ability to meet productivity and accuracy standards
  • Ability to defend coding decisions to both internal and external audits.
  • Ability to calculate payment based on provider contracts.
  • Identifies coding error (e.g., incorrect primary diagnosis, MCC's, CC's, and procedure codes) and recommends correct coding of medical claims.
  • Receives, researches, and determines appropriate coding for provider denial appeals from Correspondence, PRT, Claims, and the Markets.
  • Support claims, configuration, PRT, and/or appeal & grievances teams as necessary.
  • Performs other duties as assigned.
Additional Responsibilities:
    Performs post-payment review for Diagnosis Related Group (DRG) validation on inpatient medical records using International Classification of Diseases, Tenth Revision (ICD-10-CM) and Procedural Coding System (ICD-10-PCS) to identify incorrect coding.

    Essential Functions:
    • Reviews and analyzes inpatient hospital medical records using International Classification of Diseases, Tenth Revision (ICD-10-CM) and Procedural Coding System (ICD-10-PCS). Always coding to the highest level of specificity.
    • Follows the Official ICD-10-CM Guidelines for Coding and Reporting and the ICD-10-PCS Official Guidelines for Coding and Reporting and has a complete understanding of these guidelines.
    • Ability to meet productivity and accuracy standards
    • Ability to defend coding decisions to both internal and external audits.
    • Ability to calculate payment based on provider contracts.
    • Identifies coding error (e.g., incorrect primary diagnosis, MCC's, CC's, and procedure codes) and recommends correct coding of medical claims.
    • Receives, researches, and determines appropriate coding for provider denial appeals from Correspondence, PRT, Claims, and the Markets.
    • Support claims, configuration, PRT, and/or appeal & grievances teams as necessary.
    • Performs other duties as assigned.
    Additional Responsibilities:

    Back to top

    Join Our
    Talent Network

    and receive job alerts
    Click Here
    Last Updated On: 12/9/2015