Coding Denials & Accuracy Analyst, PIH Health Whittier Hospital, full time, days
Location: Whittier, California
Admin / Clerical
Internal Number: 15498
PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Hospital - Whittier, PIH Health Hospital - Downey and PIH Health Good Samaritan Hospital, 27 outpatient medical locations, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, women’s health, urgent care and emergency services.
The organization is recognized by Watson Health as one of the nation’s Top Hospitals, and College of Healthcare Information Management Executives (CHIME) as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. PIH Health is certified as a Great Place to Work TM. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.
The Coding Denials & Accuracy Analyst is responsible for the review, analysis, and timely response to coding denials for hospital claims and audit MSO claims for coding accuracy. Reviews and analysis will be based on coding and/or regulatory agencies’ guidelines, NCDs, LCDs, DRGs, CPT/HCPS codes, etc. Responds in writing to 1) all coding denials and provides clarifying documentation to support denial decision for hospital claims and 2) all MSO claims when coding discrepancies are identified between codes on claims and medical record documentation. Works collaboratively with coding leadership, clinical documentation leadership and MSO leadership to provide education on trends identified through the analysis.
Demonstrates expert technical knowledge of ICD-10-CM disease and procedural coding, CPT-4/HCPCS procedural coding, and inpatient (i.e. DRG, PDPM, CMG, etc.) coding.
Must have thorough knowledge of the denials process.
Must have a thorough knowledge of anatomy and physiology and medical terminology.
Excellent written and verbal communication skills
Use of Excel spreadsheet program
A high level of professionalism is needed for interaction with physicians, coders, hospital staff, MSO staff, payers, and health plans.
Knowledge of Uniform Hospital Discharge Data Set (UHDDS)
Knowledge of Case Mix Index
Current American Health Information Management Association (AHIMA) certification as a Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA) or Certified Coding Specialist (CCS)
One (1) year experience in coding auditing or denials management experience in an acute hospital setting or payer/health plan side
Experience in analysis of coded data and presentation of findings
Familiarity with computers, and encoding software and the general principles of medical record science
Associate of Science or Bachelor of Science degree in Health Information from an approved AHIMA program
Experience with education/training in ICD-10CM, CPT, and reimbursement methodologies
PIH Health is the Communities’ Health and Wellness Partner
Our network of highly trained and compassionate physicians, nurses, clinicians, staff and volunteers work tirelessly and collaboratively every day to maintain and enhance the health and wellbeing of every member of our service areas. And when needed, we are here to coordinate care, manage chronic disease, and treat health conditions for the best possible outcomes.
We’re a nonprofit, regional healthcare network with three hospitals, numerous outpatient medical offices, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services. Our leadership is dedicated to putting patients first—a cornerstone of our mission, vision and values—as we deliver top-quality healthcare.
We serve more than 3.7 million residents in the Los Angeles County, Orange County and San Gabriel Valley region.
Why PIH Health?
Our culture is built around our core values, which are the guiding principles for everything we do. For over 60 years, PIH Health has maintained a sense of community and a family-like cultur...e where patients are the top priority, and employees and volunteers are proud to be affiliated with such an outstanding organization.
PIH Health Hospital - Whittier
Our Whittier campus delivers outstanding and compassionate care to patients, every day. Among other awards, PIH Health Hospital - Whittier has been named one of the nation’s 100 Top Hospitals® for the third consecutive year by Truven Health Analytics. PIH Health Hospital in Whittier, CA is located 30 minutes east of Los Angeles, close to the Los Angeles and Orange County border. There are many great communities in which to live that surround the hospital. This means easy access to work, great dining, shopping, entertainment and spectacular beaches. Whatever your passion, you’ll find the right place for it here.
PIH Health Hospital - Downey is a nonprofit hospital with a rich, nearly 100-year history of meeting the healthcare needs of its community. The Downey campus is part of the PIH Health comprehensive health network consisting of two hospitals, 18 medical office locations and a host of specialty services. According to US News & World Report, the hospital scores highly in patient safety and orthopedics. With 955 employees, the hospital is the 5th largest employer in the city of Downey.