Job Description
Maintains responsibility for coding/DRG validation review, DRG PRO activities and assurance of optimal reimbursement. Oversees compliance with coding standards and regulations
Responsibilities
1.Advises and assists in improvement plans for coding and DRG assignment issues
2.Validates assignment of codes and provides trending and analysis of coding and DRG issues
3.Ensures provision of complete and accurate medical records to the PRO and insurance companies for the purposes of DRG and/or quality reviews
4.Reviews medical records and validates assignment of codes
5.Recognizes opportunities for revenue enhancement, within coding and compliance guidelines, and recommends accordingly
6.Recommends and effectively communicates all recommended changes with appropriate coding management staff and physicians
7.Effectively and concisely reports all findings and trends to the Medical Record Department, including trending of coding changes by codes, diagnosis or procedure, type of change (i.e.: sequencing or index related) and revenue
8.Proposes and assists in planning and executing appropriate in-service education to coding staff and documentation of in-service to physicians as related to findings
9.Presents regulatory changes in ICD-9-CM, CPT-4, and DRG methodologies
10.Provides complete and accurate medical records for the PRO and insurance companies performing coding, DRG, and quality reviews
11.Prepares and prioritizes retrieval and photocopying or printing of medical records for coding, DRG, and quality reviews
12.Reviews all potential DRG denials and responds to the PRO and insurance companies within required timeframes
13.Conducts research of any disputed recommendations
14.Provides documented support of findings
15.Utilizes departmental systems (META- chart tracking, incomplete chart, abstracting, ChartVision, transcription/dictation, correspondence, etc.) software to locate, maintain and update information.
16.Reviews medical records to assure compliance with documentation standards as regulated by the State, JCAHO and the Medical Center bylaws
17.Assists in Patients Appeal and social work requests, as needed
18.Receives, sorts and routes incoming mail, as required
19.Provides daily productivity and statistical information to supervisor/manager
20.Performs quality control verification for departmental processes and systems
21.Maintains established hospital/departmental/unit policies, procedures, objectives, quality assurance, safety, environmental and infection control
22.Assists in care and maintenance of department equipment, including reporting systems problems to Help Desk and/or appropriate departmental staff
23.Attends meetings as required, including in-service meetings
Qualifications

• Bachelors or associates degree in Health Information Management/Medical Record Administration or other health care related field preferred.
• Approximately 3-5 years coding and DRG validation experience in an acute care setting.
• Thorough knowledge of ICD-9-CM, CPT-4, DRG methodologies and all regulatory requirements associated with coding and DRG assignment.
• Certified Coding Specialist (CCS) required
• Registered Health Information Technician (RHIT) required

Non-Bargaining Unit, BII - Medical Records - STL, Mount Sinai St. Luke's
About Us
Strength Through Diversity

The Mount Sinai Health System believes that diversity, equity, and inclusion are key drivers for excellence. We share a common devotion to delivering exceptional patient care. When you join us, you become a part of Mount Sinai's unrivaled record of achievement, education, and advancement as we revolutionize medicine together. We invite you to participate actively as a part of the Mount Sinai Health System team by:

• Using a lens of equity in all aspects of patient care delivery, education, and research to promote policies and practices to allow opportunities for all to thrive and reach their potential.
• Serving as a role model confronting racist, sexist, or other inappropriate actions by speaking up, challenging exclusionary organizational practices, and standing side-by-side in support of colleagues who experience discrimination.
• Inspiring and fostering an environment of anti-racist behaviors among and between departments and co-workers.

We work hard to acquire and retain the best people and to create an inclusive, welcoming and nurturing work environment where all feel they are valued, belong and are able to professional advance. We share the belief that all employees, regardless of job title or expertise contribute to the patient experience and quality of patient care.

Explore more about this opportunity and how you can help us write a new chapter in our history!

"About the Mount Sinai Health System:

Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 43,000 employees working across eight hospitals, more than 400 outpatient practices, more than 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time - discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it. Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients' medical and emotional needs at the center of all treatment. The Health System includes approximately 7,400 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics and top 20 in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report's "Best Children's Hospitals" ranks Mount Sinai Kravis Children's Hospital among the country's best in several pediatric specialties. The Icahn School of Medicine at Mount Sinai is ranked No. 14 nationwide in National Institutes of Health funding and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges. Newsweek's "The World's Best Smart Hospitals" ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally.

The Mount Sinai Health System is an equal opportunity employer. We comply with applicable Federal civil rights laws and does not discriminate, exclude, or treat people differently on the basis of race, color, national origin, age, religion, disability, sex, sexual orientation, gender identity, or gender expression. We are passionately committed to addressing racism and its effects on our faculty, staff, students, trainees, patients, visitors, and the communities we serve. Our goal is for Mount Sinai to become an anti-racist health care and learning institution that intentionally addresses structural racism."

EOE Minorities/Women/Disabled/Veterans