DRG Validator -Coding- FT- Remote -Days

DRG Validator

Location : Atlanta, GA

Job Type : Full Time Remote

Shift/Schedule : Days

JOB SUMMARY

The Diagnosis Related Group (DRG) Validator, is responsible for reviewing inpatient coded records records in accordance with Uniform Hospital Discharge Data Set (UHDDS) Definitions to validate an inpatient admit order, assignment of and sequencing of ICD-10-CM/PCS principal and secondary diagnoses, principal and secondary procedures, the discharge disposition codes and the DRG Assignment. Solid knowledge of MS-DRG, APR-DRG (SOI/ROM), Coding Guidelines, American Hospital Association (AHA) Coding Clinic and Present on Admission (POA) Indicator Guidelines. All HACs, PSIs and focused MS-DRGs are identified by PWC SMART Application. Collaborates with Quality Department for 2nd Level quality review of all Hospital Acquired Conditions (HACs) and selected AHRQ Patient Safety Indicators (PSIs). Works with Clinical Documentation Improvement (CDI) Manager, upon request will performs 2nd level review of identified cases for appropriate assignment of Severity of Illness (SOI) and Risk of Mortality (ROM) utilizing the APR-DRG. Performs chart review for DRG Claim Review Requests and determine correctness of original vs. recommended MS-DRG. The DRG Validator assists the Coding Manager with identifying coding trends for education based on audit findings. As needed, performs inpatient coding of accounts.

JOB RESPONSIBILITIES

Description Performs daily coding reviews for HACs, selected PSIs and focused DRGs on inpatient records identified by SMART to validate the assigned ICD-10 CM/PCS Codes and Present of Admission (POA) assignment.

Works with Executive Director of HIM and Corporate Coding & Reimbursement Manager to develop process improvements to maintain data quality.

As needed, assist with coding of accounts Completes special projects as assigned, other duties as assigned.

Send notifications to the Quality Department (Quality Reviewer) to conduct a Quality Level review on cases in which the PSI/HAC Diagnosis and/or POA indicators are in alignment with documentation.

Reviews selected records, validating secondary diagnoses and procedures to ensure compliance with all reporting requirements.

Write concise rationale to support audit findings and DRG Claim Review Appeal letters, referencing applicable official guidelines, when applicable

Evaluates the quality of clinical documentation to identify incomplete or ambiguous documentation for inpatient encounters that impact the code selection and resulting DRG assignment and reimbursement

Utilizing SMART Tool, ability to perform data analysis and identify trends for Coding/CDI opportunities and provide feedback to assure coding uniformity, consistency and accuracy with ICD-10-CM/PCS.

Works closely with the Clinical Documentation Improvement Manager in pre-bill review of Mortality charts and Hospital Acquired Conditions (HACs), and specific diagnosis or DRG's as assigned.

Collaborates with the Coding Vendor to provide input for development of educational areas for inpatient coding involving both internal and external training.

Works jointly with Independent Coding Auditor regarding recommendations for revisions to diagnoses and/or procedures, queries and HIM DRG spreadsheet.

EDUCATION

Required:

Formal Health Information Management (HIM) education with national of Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT)

EXPERIENCE

Required:

Five (5) years or more of progressive inpatient coding in an acute care hospital and coding review experience in ICD-10- CM/PCS. Two years of auditing experience or strong training background in coding and reimbursement.

SKILLS/CERTS/LICENSES:

Required:

Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) and Certified Coding Specialist (CCS).

Ability to work independently in a multi-task remote environment.

Good interpersonal and communication skills in dealing with physicians and other health professionals.

Excellent decision making and problem solving skills and ability to work in a team environment

Preferred:

Certified Documentation Improvement Practitioner (CDIP). Certified Clinical Documentation Specialist (CCDS).

Equal Opportunity Employer-Minorities/Females/Veterans/Individuals with Disabilities/Sexual Orientation/Gender Identity.