HIM DRG Coordinator

The information described in this job description has been designed to indicate the general nature of the work performed. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this job.

Other information:

Job Summary
Responsible for performing DRG validation reviews of medical records and/or other documentation to validate the conditions that were documented in the medical record, the ICD-10-CM/PCS code assignments and determine the accuracy of DRG assignment that is clinically supported as defined by review methodologies. This involves accessing Epic systems to audit medical records, accurately documenting findings and providing policy/regulatory support for determination. The candidate must have extensive clinical experience with a background in auditing medical records with a high level of understanding payment methodologies including Major Diagnostic Categories (MDC’s); MS-DRG and APR-DRG’s.
Demonstrate the ability to collect, generate, and display data related to the top 10 DRG’s and procedures on all analytical data upon request. Performs inpatient coding by assigning ICD-CM and ICD-PCS codes as well as DRG assignment. Ensures the accuracy of patient data by appealing and validating coding and clinical validation denials, in partnership with HIM Coding Manager, Coding Supervisor, Revenue Cycle, Coding, Quality, Physician Advisors, and other health care team members.
Must have a good understanding of Epic Coding Workqueues is required.

Essential Functions
Performs audits of medical record documentation to determine the accuracy of principal and secondary diagnosis (including MCC & CC) and procedure codes. Adheres to official coding guidelines, coding clinics and regulatory guidelines and mandates.
Draws on advanced ICD-10 coding expertise and clinical knowledge to substantiate conclusions. Applies clinical review judgment to make coding validation determinations including sequencing ICD-10-CM, ICD-10-PCS procedural codes for inpatient claims.
Consistently achieves productivity and quality performance standards established by management. Verifies assignment of DRGs, MCC/CCs, Hospital Acquired Conditions (HACs) and Patient Safety Indicators (PSIs) that most appropriately reflect documentation of the occurrence of events, severity of illness, and resources utilized during the inpatient encounter and in compliance with department policies and procedures.
Selects the optimal principal diagnoses with appropriate POA indicator assignment and consulting on sequencing of risk adjustment diagnoses following established guidelines. Ensures the validity and accuracy of ICD coding, Diagnosis Related Group (DRG), Severity of Illness (SOI), Risk of Mortality (ROM), in compliance with all Federal and State coding regulations and reporting requirements.
Uses knowledge of coding and compliance guidelines to identify potential documentation, coding and reimbursement issues and report these to coding leadership. Maintains dynamic communication with physician advisors on simple visit coding edits, coders coding quality and CDI teams to identify root cause of coding and clinical validation denials.
Seeks to resolve incongruence with appropriately assigned final DRG by providing feedback and trended data back to key groups. Analyzes provider data looking for individual, group, and peer outlier denial trends that could benefit from additional education while working with the CDI Specialist. Convey support and education as needed to providers focused on improving processes and the quality of their documentation on a case-by-case basis to accurately reflect patient care in the medical record.
Creates & provides reports of cases with missing, ambiguous, contradictory, etc. documentation to assist with improvement of physician documentation which supports code assignments and prevents denials. i.e., cut and pasting documentation.
Provides professional expertise and collaborates with clinical documentation specialists on coding and documentation practices and standards. Collaborates with Coding and CDI to develop and maintain coding curriculum and training materials. Provides feedback, supporting documentation for code changes, and education to the coders, CDI, Quality, and physicians. Participates in on site, remote and/or external training workshops and training. Attends and participates in CDI-Coding Task Force and other collaborative training and education with CDI, PFS, Specialty areas and Quality. Perform other duties as assigned.
Identifies trends in coding reviews and makes suggestions for continual process improvement. Partner with CDI specialists and physicians to clarify documentation through compliant queries, ensuring it supports the most accurate and highest-weighted DRG. Monitor the financial status of Medicare patient accounts to maximize legitimate reimbursement and minimize potential losses or denials. Complete all mandatory learning requirements in a timely manner. Maintain current licensure and/or certification as required. Attend and actively participate in all department, team, and/or committee meetings. Comply with all Skagit Regional Health, department and location specific policies and procedures. Perform other duties as assigned by Supervisor or designee.

Education
High School diploma or GED required. Completion of a certification program Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) or Certified Coding Specialist (CCS) required. Associate or bachelor’s degree in health information management (HIM) preferred.

Experience/Training
Four (4) years inpatient coding and abstracting with healthcare coding experience in acute care setting. Experience with denials preferred.

License/Certifications
Certified Coder certification is required at time of hire - CPC, RHIA, RHIT, CCS or CCA Certifications.

Other Skills
Effective verbal, written and interpersonal communication skills required. Well-developed critical thinking skills required. Must be able to effectively prioritize workload amongst frequent interruptions with competing priorities. Knowledge of the healthcare environment required. Ability to coordinate work schedule with requirements of position (may include overtime and weekend work).

Physical Demands and Work Environment
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and hear. This position is regularly active and requires standing, walking, bending, kneeling, stooping, crouching, crawling, and climbing all day. The employee must frequently lift or move objects and patients weighing over 50 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to focus.