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DRG Medical Coding Specialist* - Tampa

Company: Wellcare Health Plans
Location: Tampa
Posted on: November 11, 2019

Job Description:

Location: Tampa, FL 33634Reports to: Appeals ManagerDepartment: Health Services - AppealsJob Type: Non-exempt - HourlyPerforms 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 standardsAbility 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.Candidate Education: Required A High School or GED Candidate Experience: Required 2 years of experience in professional coding experience either in a hospital or physician setting Preferred Other Healthcare industry experience Candidate Skills: Intermediate Demonstrated interpersonal/verbal communication skills Intermediate Demonstrated written communication skills Intermediate Ability to work as part of a team Advanced Ability to analyze and interpret financial data in order to coordinate the preparation of financial records Intermediate Ability to work independently Intermediate Other Working knowledge of CMS Official Guidelines for Coding and Reporting Licenses and Certifications:A license in one of the following is required: Required Other Coding Certification through either AHIMA or AAPC Preferred Certified Coding Specialist (CCS) Preferred Certified Procedural Coder - Hospital (CPC-H) Preferred Other RHIA or RHIT or CPC or CCS-P or CPC-I Technical Skills: 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 Languages:About usHeadquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.

Keywords: Wellcare Health Plans, Tampa , DRG Medical Coding Specialist* - Tampa, Healthcare , Tampa, Florida

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