DRG Denials Analyst

With over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern is committed to excellence, innovation, teamwork, and compassion. As a world-renowned medical and research center, we strive to provide the best possible care, resources, and benefits for our valued employees. Ranked as the #1 hospital in Dallas-Fort Worth for the sixth consecutive year, we invite you to continue your healthcare career with us at William P. Clements Jr. University Hospital. You'll discover a culture of teamwork, professionalism, and consistent opportunities for learning and advancement into leadership roles

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To learn more about the benefits UT Southwestern offers visit https://www.utsouthwestern.edu/employees/hr-resources/.

Summary

The DRG Denials Analyst primary responsibilities are to review coding denials for inpatient hospital medical records, for accuracy of assigned codes, and ensure all Official Coding Guidelines and conventions were followed. Also, to ensure the clinical evidence and provider documentation supports the assigned codes and DRG.

Compose and submit appeal letters as appropriate, identify coding trends/opportunities for root causes of denials, which would be relevant for additional education to individual Coders/CDI Specialist's and/or the entire Coding/CDI Teams. Report these trends/opportunities to the Clinical and Coding DRG Denials Supervisor to ensure education is developed and provided to the Coders and/or CDI Teams. Identify and communicate front-end activities that influence the denials/appeals process, seeking opportunities for process improvement.

Experience and Education

MINIMUM QUALIFICATIONS

Education/Experience

• Required - three to five (3-5) year's acute hospital-based Coding and/or CDI experience. An equivalent combination of education and experience may be considered
• Required - Registered Health Information Administrator (RHIA), or Registered Health Information Technician (RHIT), or AHIMA Certified Coding Specialist (CCS), or (CCDS) Certified Clinical Documentation Specialist, or (CDIP) Certified Documentation Improvement Practitioner
• Preferred - RN with CDI experience
• Required - Denials and Appeals experience in an acute Hospital setting
• Required - Experience working in a remote environment

Job Duties

1. Review coding and/or clinical denials, ensuring all coding guidelines and conventions were followed, and ensuring all clinical evidence and provider documentation supports the assigned codes and DRG.
2. Compose an effective appeal utilizing appropriate coding guidelines, relevant and effective clinical documentation, current industry guidelines, evidence-based medicine, and local and national medical management standards and protocols.
3. Identify coding and/or documentation trends for root causes of denials.
4. Identify and communicate DRG changes and financial impact.
5. Identify coding and clinical educational opportunities and report these to the Clinical and Coding DRG Denials Supervisor.
6. Identify front-end activities that influence denial/appeals process.
7. Support the Quality Standards set by UTSW and the HIM Coding & CDI Department.
8. Maintains an expert level of knowledge of Coding/CDI guidelines and practices.
9. Other duties as assigned.

Knowledge, Skills & Abilities

• Work requires strong Coding/CDI knowledge and skills, including but not limited to I-10CM &

I-10PCS, Official Coding Guidelines, and conventions, knowledge to interpret and apply Coding and CDI guidelines, etc.

• Work requires strong analytical and critical thinking skills
• Work requires excellent communication skills (written and verbal), customer service, and interpersonal skills
• Work requires organizational skills along with a high level of accuracy and attention to detail
• Work requires ability to report and problem solve using discretion, judgment, and professionalism
• Work requires ability to handle multiple tasks, show initiative, and adjust to changes as appropriate, in an environment where change is common
• Work requires ability to perform in a conservative, fast-paced, and quality driven environment
• Work requires ability to comprehend, understand, and follow established policies, procedures, and other guidelines of some complexity
• Work requires self-motivation, maturity, and being a team player

Working Conditions
This job is Majority Remote.

This position will report to the Clinical and Coding DRG Denials Supervisor.

Any qualifications to be considered as equivalents in lieu of stated minimums require prior approval of the Vice President for Human Resources Administration, or his/her designee.

Security

This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information

UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status.

UT Southwestern is proud to offer a competitive and comprehensive benefits package to eligible employees. Our benefits are designed to support your overall wellbeing, and include:
• PPO medical plan, available day one at no cost for full-time employee-only coverage
• 100% coverage for preventive healthcare - no copay
• Paid Time Off, available day one
• Retirement Programs through the Teacher Retirement System of Texas (TRS)
• Paid Parental Leave Benefit
• Wellness programs
• Tuition Reimbursement
• Public Service Loan Forgiveness (PSLF) Qualified Employer
• Learn more about these and other UTSW employee benefits!