DRG Integrity Specialist
Description:
Job Type
Full-time
Description
As a valued member of the DRG Review Team, the DRG Integrity Specialist performs a secondary level review of medical records and code assignment using knowledge of Accuity technology and client systems with a physician in accordance with federal coding regulations and guidelines as well as client specific coding guidelines to ensure accurate DRG assignment. This function requires a broad knowledge of the compliance structure to support the appropriate reimbursement.
PRIMARY JOB RESPONSIBILITIES:
Review pre-bill cases simultaneously with a physician during each work shift excluding breaks and meetings to analyze and validate diagnosis and procedure codes for inpatient services via coding compliance and clinical knowledge to support accurate DRG assignment
Utilizes Accuity technology for tracking of coding errors, query opportunities and other data collection as needed
Researches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, and client denials
Possesses a high level of dependability and ability to meet Accuity coding recommendations, accuracy rate, and production standards
Interacts with Accuity physicians, peers, CDIS, and management regarding documentation, policies, procedures, and regulations
Interacts with management on an ongoing basis including assisting senior level staff in providing recommendations for process improvement so that productivity and quality goals can be met or exceeded, and operational efficiency and financial accuracy can be achieved
Reviews, develops, modifies, and/or adapts relevant client procedures, protocols, and systems to coordinate with Accuity methodology
Creates and provides group education and training based on accurate coding practices, coding compliance documentation, and regulatory provisions
Attends in-house training sessions to receive updated coding information and changes in coding and/or regulations
Adheres to stringent timelines consistent with project deadlines and directives
Ensures strict confidentiality of patient medical records
Always acts in an ethical and collaborative manner while monitoring own work to help ensure quality
Codes medical records as needed based on organizational needs
Performs miscellaneous job-related duties as assigned
III. POSITION QUALIFICATIONS:
Education:
High School Diploma or GED required
Associates Degree in Health Information Management or similar preferred
Experience:
Minimum 4 years of inpatient coding experience in hospital facility coding
Minimum 2 years of experience that is directly related to the duties and responsibilities specified above
Experience and knowledge in DRG reimbursement (i.e., MS-DRG, APR-DRG)
Licensure and/or Credentials:
Coding credential required from AHIMA/AAPC (RHIA, RHIT, CCS and/or CPC)
Knowledge, Skills, and Abilities:
Knowledge of auditing concepts and principles
Expert of coding guidelines
Ability to use independent judgment and to manage and impart confidential information
Advanced knowledge of medical coding, electronic medical record systems, coding systems
Critical thinking skills to analyze and solve problems
Strong communication and interpersonal skills
Knowledge of legal, regulatory, and policy compliance issues related to medical coding and documentation
Knowledge of current and developing issues and trends in medical coding diagnosis and procedure code assignment
Ability to clearly communicate medical information to physicians and CDIS staff
Ability to provide guidance and training to when needed
Ability to use a PC in a Windows environment, including MS Word
Independent, focused individual able to work remotely or on-site Requirements
POSITION QUALIFICATIONS:
High School Diploma or GED required
Associates Degree in Health Information Management or similar preferred
Experience:
Minimum 4 years of inpatient coding experience in hospital facility coding
Minimum 2 years of experience that is directly related to the duties and responsibilities specified above
Experience and knowledge in DRG reimbursement (i.e., MS-DRG, APR-DRG)
Licensure and/or Credentials:
Coding credential required from AHIMA/AAPC (RHIA, RHIT, CCS and/or CPC)
Knowledge, Skills, and Abilities:
Knowledge of auditing concepts and principles
Expert of coding guidelines
Ability to use independent judgment and to manage and impart confidential information
Advanced knowledge of medical coding, electronic medical record systems, coding systems
Critical thinking skills to analyze and solve problems
Strong communication and interpersonal skills
Knowledge of legal, regulatory, and policy compliance issues related to medical coding and documentation
Knowledge of current and developing issues and trends in medical coding diagnosis and procedure code assignment
Ability to clearly communicate medical information to physicians and CDIS staff
Ability to provide guidance and training to when needed
Ability to use a PC in a Windows environment, including MS Word
Independent, focused individual able to work remotely or on-site