DRG Valid & Qual Meas Auditor (Full-Time, 40, Day)

RESPONSIBILITIES

I. JOB SUMMARY/RESPONSIBILITIES:

• Under general supervision of the Coding Manager, performs targeted pre-bill or post-bill validation reviews to identify coding issues and opportunities.

• Verifies accurate diagnosis and procedure code assignments to substantiate proper reimbursement and quality measures reporting for the organization.

II. TYPICAL PHYSICAL DEMANDS:

• Essential: sitting, stooping/bending, finger dexterity, seeing, hearing, speaking, lifting, and carrying usual weight of 5 pounds, repetitive arm/hand motions, static gripping of an object for prolonged periods, frequent gripping of an object.

• Occasional: standing, walking, kneeling, climbing stairs, squatting, twisting body, lifting weight up to 10 pounds, pushing/pulling usual weight of 2 pounds up to 5 pounds of force, reaching above, at and below shoulder level.

• Operates computer, calculator, and telephone.

III. TYPICAL WORKING CONDITIONS:

• Not substantially subjected to adverse environmental conditions.

IV. MINIMUM QUALIFICATIONS:

A. EDUCATION/CERTIFICATION AND LICENSURE:

• Current certification as a Certified Coding Specialist (CCS) by the American Health Information Management Association (AHIMA).

• Bachelor’s degree in health information management or related field preferred.

• Current certification in the following preferred:

o Certified Risk Adjustment Coder (CRC) from the American Academy of Professional Coders (AAPC).

o Approved ICD-10-CM/PCS Trainer from the American Health Information Management Association (AHIMA).

o Certified Clinical Documentation Specialist (CCDS) from The Association of Clinical Documentation Integrity Specialists (ACDIS).

B. EXPERIENCE:

• Five (5) years experience in inpatient coding and auditing.

• Three (3) years of prior technical experience using multiple health information systems such as Epic, Optum CAC, and Varian.

• Proficient in medical terminology, pharmacology, body systems/anatomy, physiology, and disease processes and treatments.

• Expertise in inpatient prospective payment system (IPPS) and Medicare Severity (MS)-DRG and All Patient Refined (APR)-DRG reimbursement methodologies.

• Knowledge of quality measures such as patient safety indicators (PSI), risk-adjusted mortalities, and hospital readmission rates.

• Skilled in writing clear, compelling, and concise justifications in support of review findings and ability to successfully craft appeal letters with precise logic.

• Proficient in Microsoft Office applications (i.e. Word, Excel, and PowerPoint).

• Ability to work under pressure and meet deadlines while maintaining a positive and professional attitude.

• Experience performing clinical validation reviews preferred.

Equal Opportunity Employer/Disability/Vet