- Review pre-bill cases simultaneously with a physician and/or mid-level provider during each work shift excluding breaks and meetings to analyze and validate diagnosis and procedure codes for inpatient services via coding compliance and clinical knowledge to support accurate DRG assignment.
- Utilizes technology for tracking coding errors, query opportunities and other data collection as needed.
- Researches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, and client denials.
- Possesses an elevated level of dependability and ability to meet coding recommendations, accuracy rate, and production standards.
- Interacts with physicians, peers, CDIS, and management regarding documentation, policies, procedures, and regulations.
- Interacts with management on an ongoing basis in supplying recommendations for process improvement so that productivity and quality goals can be met or exceeded, and operational efficiency and financial accuracy can be achieved.
- Reviews, develops, modifies, and/or adapts relevant client procedures, protocols, and systems to coordinate with methodology.
- Creates and provides group education and training based on accurate coding practices, coding compliance documentation, and regulatory provisions.
- Attends in-house training sessions to receive updated coding information and changes in coding and/or regulations.
- Adheres to stringent timelines consistent with project deadlines and directives.
- Ensures strict confidentiality of patient medical records.
- Codes medical records as needed based on organizational needs.
- Performs miscellaneous job-related duties as assigned.
- High school diploma or equivalent.
- Coding credential required from AHIMA/AAPC (RHIA, RHIT, CCS and/or CPC).
- Minimum 4 years of inpatient coding experience in hospital facility coding
- Minimum 2 years of experience that is directly related to the duties and responsibilities specified above
- Experience and knowledge in DRG reimbursement (i.e., MS-DRG, APR-DRG)
- Knowledge of auditing concepts and principles.
- Expert of coding guidelines.
- Ability to use independent judgment and to manage and impart confidential information.
- Advanced knowledge of medical coding, electronic medical record systems, coding systems.
- Critical thinking skills to analyze and solve problems.
- Effective communication and interpersonal skills.
- Knowledge of legal, regulatory, and policy compliance issues related to medical coding and documentation.
- Knowledge of current and developing issues and trends in medical coding diagnosis and procedure code assignment
- Ability to clearly communicate medical information to physicians and CDIS staff.
- Ability to supply guidance and training to when needed.
- Ability to use a PC in a Windows environment, including MS Word.
- Independent, focused individual able to work remotely or on-site.
- Associates Degree in Health Information Management or similar preferred.
- Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time or exerting up to 15 pounds of force occasionally or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body.
- No potential for exposure to blood and body fluids.
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DRG Integrity Specialist - Atlanta, United States - Shepherd Center
Description
Shepherd Center, located in Atlanta, Georgia, is a private, not-for-profit hospital specializing in medical treatment, research and rehabilitation for people with spinal cord injury, brain injury, stroke, multiple sclerosis, spine and chronic pain, and other neuromuscular conditions.Join us in our mission to help people with a temporary or permanent disability, rebuild their lives with hope, independence and dignity, advocating for their full inclusion in all aspects of community life.
At Shepherd Center, you'll discover a diverse and inclusive environment, enlightened leadership, a culture of teamwork, professionalism and mutual respect. If you are seeking career advancement, continuing education opportunities coupled with a welcoming and fun workplace, competitive compensation and employment benefits, visit our careers page to explore current openings.
The DRG Integrity Specialist performs a secondary level review of medical records and code assignment using knowledge of Accuity technology and client systems with a physician in accordance with federal coding regulations and guidelines as well as client specific coding guidelines to ensure accurate DRG assignment. This function requires a broad knowledge of the compliance structure to support the proper reimbursement.
