Job Details
Job TypeFull-time
DescriptionPosition Title:
DRG Integrity SpecialistLocation:
RemoteDepartment:
DRG IntegrityPOSITION SUMMARY: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 assignmentUtilizes Accuity technology for tracking of coding errors, query opportunities and other data collection as neededResearches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, and client denialsPossesses a high level of dependability and ability to meet Accuity coding recommendations, accuracy rate, and production standardsInteracts with Accuity physicians, peers, CDIS, and management regarding documentation, policies, procedures, and regulationsInteracts 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 achievedReviews, develops, modifies, and/or adapts relevant client procedures, protocols, and systems to coordinate with Accuity methodologyCreates and provides group education and training based on accurate coding practices, coding compliance documentation, and regulatory provisionsAttends in-house training sessions to receive updated coding information and changes in coding and/or regulationsAdheres to stringent timelines consistent with project deadlines and directivesEnsures strict confidentiality of patient medical recordsAlways acts in an ethical and collaborative manner while monitoring own work to help ensure qualityCodes medical records as needed based on organizational needsPerforms miscellaneous job-related duties as assigned
RequirementsPOSITION QUALIFICATIONS:Education :High School Diploma or GED requiredAssociates Degree in Health Information Management or similar preferredExperience:Minimum 4 years of inpatient coding experience in hospital facility codingMinimum 2 years of experience that is directly related to the duties and responsibilities specified aboveExperience 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, or CIC)Knowledge, Skills, and Abilities:Knowledge of auditing concepts and principlesExpert of coding guidelinesAbility to use independent judgment and to manage and impart confidential informationAdvanced knowledge of medical coding, electronic medical record systems, coding systemsCritical thinking skills to analyze and solve problemsStrong communication and interpersonal skillsKnowledge of legal, regulatory, and policy compliance issues related to medical coding and documentationKnowledge of current and developing issues and trends in medical coding diagnosis and procedure code assignmentAbility to clearly communicate medical information to physicians and CDIS staffAbility to provide guidance and training to when neededAbility to use a PC in a Windows environment, including MS WordIndependent, focused individual able to work remotely or on-site
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