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Corporate Functions & Operations WellCare - Coding & Records Careers

Medical Coding Specialist Job

Full Job Title: DRG Medical Coding Specialist

Job Number: 1800615

Location: Tampa, FL

Date Posted: 1-25-2018

Work from Home option after 90 with demonstrated proficiency with WellCare systems and Coding expertise.

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:
    LI - MW1*
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:

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Last Updated On: 12/9/2015