DRG Validator

Inpatient DRG Validation & Coding Analyst

Summary:

The Inpatient DRG Validation & Coding Analyst will work closely with the Supervisor/ Manager of Revenue Integrity Services to achieve the Revenue Integrity Service Line's goals and objectives and Company-wide goals and initiatives. The Inpatient DRG Validation & Coding Analyst will be responsible for supporting the client's Revenue Integrity Service Line by providing inpatient coding reviews, as well as supporting other client Service Lines. The Inpatient DRG Validation & Coding Analyst will utilize the client's proprietary revenue integrity platform and their unique experience to identify revenue integrity related issues for our customers.

Essential Duties and Responsibilities:

• Utilizing the client's revenue integrity platform, review claims at all levels of complexity for inpatient claims
• Ability to read, decipher and analyze all aspects of medical record documentation for accurate coding.
• Responsible for reviewing inpatient coding (ICD-10-CM and ICD-10-PCS codes) to ensure accuracy and completeness of records coded by the coding staff for multiple clients.
• Validate the ICD-10-CM and PCS codes, principal and secondary diagnoses
• Assignment appropriateness to ensure consistency and efficiency and to optimize DRG reimbursement and facilitate data quality in hospital inpatient services.
• Review physician documentation for specificity, completeness, and quality to support coding accuracy, and to identify physician query opportunities to improve the documentation.
• Maintains current knowledge of regulatory agencies standards, i.e., CMS, OIG, AHA, Coding Clinics etc.
• Maintain required coding credential(s)
• Seeks opportunities for individual growth and development, including attending various meetings, conferences, and courses, as required
• Responsible for meeting departmental productivity and quality expectations.
• Consult with client organizations and their department heads at the direction of the service line director.
• Collaborate with other service line team members to meet client demands and to develop strategies for service line growth and operational improvement.
• Contribute to developing coding education and training and institutional coding policies to achieve coding excellence and to enhance internal, proprietary software used as an analytical tool.

Education and/or Experience:

• RHIA or RHIT a plus, CCS credential required.
• Experience with DRG validation (1-2 years)
• A minimum, 1-2 years' experience with Coding IP Claims
• Experience with Medicare and Medicaid DRGs.
• Experience with OP coding is a plus.
• Strong coding knowledge and follow the official coding rules, guidelines, and conventions to validate coded data and ensure high quality and compliance with regulatory requirements.
• Demonstrates competency in the use of computer applications in the EHR (i.e., Cerner, EPIC, Meditech, etc.) and knowledge in DRG grouping software.
• Computer proficiency as related to MS Office and in-house proprietary software.
• Demonstrates knowledge in hospital/healthcare settings such as revenue cycle, coding, and reimbursement.
• Knowledge of ICD-10-CM/PCS required
• ICD-10-CM/PCS AHIMA Approved Trainer experience highly desired.
• Excellent oral and written communication skills, including the ability to interact with high- level of management.
• Detailed-oriented and able to meet targeted deadlines.
• Bachelor of Science degree in a related field, Associates in Health Information

Shift:

• Employees are required to work eight (8) hours minimum per day, Monday through Friday, which excludes the standard 45-minute lunch break.
• 7:30am - 4pm
• 8am - 4:30pm
• 8:30am - 5pm
• 9am - 5:30pm
• 9:30am - 6pm

Additional skill sets / experience desired:

• Experience looking for missed charges
• CDI training or experience
• Client facing ability
• Preparing and giving webinars and/or white papers
• Comfortable with APR and MS DRG assignment

Benefits include:

• Medical/ Dental/ Prescription/ Vision - Start on Date of Hire
• Paid Time Off
• 401(k) Retirement Plan
• Company Paid Life Insurance
• Medical and Dependent Care FSA
• Tuition Reimbursement
• Flexible Work Schedule

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.