Department: Health Services, DRG Validation
Reports to: Supervisor. DRG Medical Coding
Location: 8735 Henderson Road, Tampa FL 33634
PLEASE NOTE: This is a work from work position with potential for 2 days work from home once all production metrics have been met.
WellCare has an immediate opportunity for an experienced DRG Medical Coding Specialist to join our team! This position is based at our Tampa (Henderson Road) location and is convenient to Tampa International Airport, International Plaza and the Westshore district. This location has an on campus cafeteria as well as a fitness center which is free for WellCare employees. This position offers a full benefits package, including 3 weeks of paid time off. Our ideal candidate will have their CCS or CIC and have a minimum of 2 years of professional coding experience in a hospital or physician setting.
In addition to meeting essential requirements, our ideal candidate will be someone that has experience in adobe PDF Editor and Optum’s WebStrat. While this position performs inpatient coding, there is also a future opportunity to learn more and conduct outpatient coding.
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.
Additional Responsibilities: Candidate Education:
- 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.
- Required A High School or GED
- Required 2 years of experience in professional coding experience either in a hospital or physician setting
- Preferred Other Healthcare industry experience
Licenses and Certifications:
- Intermediate Demonstrated interpersonal/verbal communication skills
- Intermediate Demonstrated written communication skills
- Intermediate Ability to work as part of a team
- Advanced Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
- Intermediate Ability to work independently
- Intermediate Other Working knowledge of CMS Official Guidelines for Coding and Reporting
A license in one of the following is required:
- Required Certified Coding Specialist (CCS)
- Preferred Other Certified Inpatient Coder - Hospital (CIC)
- Required Intermediate Microsoft Outlook
- Required Intermediate Microsoft Excel
- Required Intermediate Microsoft Word
- Required Intermediate Healthcare Management Systems (Generic)
- Required Advanced Other strong knowledge of medical terminology & abbreviations
- Required Intermediate Other working knowledge of MUE’s, LCD’s, and other coding resources from CMS