DRG Reviewer

Overview:

How you move is why we’re here. ®

Now more than ever.

Get back to what you need and love to do.

The possibilities are endless...

Now more than ever, our guiding principles are helping us in our search for exceptional talent - candidates who align with our unique workplace culture and who want to maximize

the abundant opportunities for growth and success.

If this describes you then let’s talk!

HSS is consistently among the top-ranked hospitals for orthopedics and rheumatology by U.S. News & World Report. As a recipient of the Magnet Award for Nursing Excellence, HSS was the first hospital in New York City to receive the distinguished designation. Whether you are early in your career or an expert in your field, you will find HSS an innovative, supportive and inclusive environment.

Working with colleagues who love what they do and are deeply committed to our Mission, you too can be part of our transformation across the enterprise.

DRG Reviewer

Full-Time

The DRG Reviewer reports to the Director of Coding, HIM (Health Information Management). The DRG Reviewer oversees DRG accuracy. The DRG Reviewer will ensure that accurate, coded data exists for optimal reimbursement by the organization, while also ensuring compliant and accurate inpatient coding.

PRIMARY RESPONSIBILITIES

Monitors coding and documentation accuracy.

Conducts retrospective review of the medical record to increase accuracy, clarity, and specificity of provider documentation.

Aids in coding and 1st level reviews in event of workload and staffing events.

Assist in developing educational and training programs regarding elements of coding such as appropriate documentation, accurate coding, coding trends found during chart reviews, third party audit findings, and annual coding updates.

Provides feedback for physician queries to clarify ambiguous, conflicting, or incomplete documentation.

Works closely with Clinical Documentation Improvement (CDI) to identify areas of documentation in need of improvement.

Keeps abreast of coding guidelines and reimbursement reporting requirements. Maintains credentials.

Maintains health information confidentiality by adhering to established organizational and departmental policies and procedures.

Coordinates and maintains Coding Clinic questions and responses.

Coordinates and maintains 3M Nosology questions and responses.

Keeps Coding Department Notebook up to date with education and regulatory information.

Assist in establishing best practices and lead continuous improvement that ensures systems and workflows achieve the highest level of accuracy and productivity.

Serve as a resource related to Coding issues throughout the HSS system. Function as the regional hub for all Coding activities, supporting physician practice offices, off sight facilities and affiliated hospitals.

Work closely with Denial Management to effectively respond to DRG downgrades and other reimbursement challenges.

Performs other duties as assigned (i.e. correction of accts with invalid principal diagnoses, SPARC reviews, miscellaneous work queues, etc.)

Ensures timely feedback and focused educational programs on the results of auditing and monitoring activities.

Oversight of coding educational programs to ensure all providers, coding staff and other personnel maintain compliance with coding requirements and governmental regulations.

Collaborates with other departments to resolve operational issues and prioritize process improvement activities.

Ensures information is reported timely and accurately to New York State DOH registries for patients meeting requirements for oncology (tumor registry), Alzheimer's, and Congenital Malformations.

Qualifications:

Education:

Associate degree required.

Certifications:

A minimum of one of the following certifications is required and must be maintained: American Health Information Management Association (AHIMA) Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), or the American Academy of Professional Coders (AAPC) Certified Inpatient Coder (CIC).

Work Experience:

A minimum of 5 years of experience in hospital inpatient, or integrated healthcare delivery system coding role involving the accurate interpretation and coding/abstraction of therapeutic/diagnostic measures and procedures of a diverse patient population such as a coder, coding auditor or coding instructor.

Knowledge and understanding of ICD-10-CM, CPT, Modifiers & HCPCS coding classification and guidelines

Knowledge and understanding of medical terminology, disease process and anatomy and physiology

Other Requirements:

#LI-Hybrid

Permanent