Job Requirements
POSITION SUMMARY
To be fully engaged in providing excellence by performing inpatient DRG reviews, auditing for coding
and abstracting compliance and accuracy. Collaboratively working as a key member of a
multidisciplinary team.
PRIMARY ACCOUNTABILITES
1. Performs daily focus DRG prebill monitoring of accounts assigned.
2. Performs inpatient coder quality audits, reporting results to Coding Leadership monthly and
always promoting a collaborative effort to solve quality opportunities.
3. Responsible for keeping abreast of new regulatory requirements, revisions, updates, and DRG
changes in the coding arena by education, research, and networking.
4. Facilitates probe and spot inpatient audits as requested by Coding Leadership or outside
departments.
5. Maintain a record of all inpatient audits performed to include, sample pull, audit results, rebuttal
process, corrections/rebills as necessary, educational action plan, and follow-up audit as
necessary.
6. Demonstrate ability and competency to navigate the legal health record accurately and
efficiently for data quality collection and code assignment.
7. Facilitates completion of the annual departmental inpatient audit plan components.
8. Performs and oversees reconciliation and follow-up of RAC and private insurance reviews of
potential DRG revision recommendations.
9. Review and validate assignment of ICD-10 diagnosis and procedure codes based upon
physician documentation in the medical record in accordance with coding and compliance
guidelines.
10. Verify diagnosis, procedures, and DRG optimization and accuracy by utilizing the 3M Encoder
Analyzer tool as well as any other resources available.
11. Facilitate DRG/code change recommendations received from outside entities communicating
appropriately and timely as per the appeal instructions indicated.
12. Request clarification from provider when there is conflicting, incomplete, or ambiguous
information in the health record regarding a significant reportable condition or procedure or
other reportable data element.
13. Provides timely notification to medical records/registration personnel of any identified
discrepancies of patient information in the medical record.
14. Attends monthly department meetings and bi-monthly coding/CDI roundtables.
15. Maintain and observes patient confidentiality as outlined in the National Patient Safety Goals
and HIPAA guidelines that protects the confidentiality of the health record and refuses to access
protected health information not required for coding/auditing related activities.
Work Experience
MINIMUM QUALIFICATIONS
PREFERRED QUALIFICATIONS
PHYSICAL REQUIREMENTS
to moderate noise.
personal vehicle
Benefits
ABOUT HEALTH FIRST
At Health First, diversity and inclusion are essential for our continued growth and evolution. Working together, we strive to build and nurture a culture that recognizes, encourages, and respects the diverse voices of our associates. We know through experience that different ideas, perspectives, and backgrounds create a stronger and more collaborative work environment that delivers better results. As an organization, it fuels our innovation and connects us closer to our associates, customers, and the communities we serve.
Schedule : Full-Time
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