DRG Integrity Specialist

POSITION 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 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

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, or CIC)

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