DRG ValidatorJob Ref: 18448
Category: Professional & Management
Department: Medical Records
Schedule: Full Time
Shift: Day shift
Under the general director of the Manager, Clinical Documentation and Coding, this position is responsible for performing quality reviews of records for documentation and coding to validate the ICD diagnoses/procedures and DRG assignments appropriateness to ensure consistency and efficiency in inpatient claims processing and data collection to optimize DRG reimbursement and facilitate data quality in hospital inpatient services.
Bachelor’s year degree required; concentration in Health Information Management preferred.
Minimum of 5 years of progressive, inpatient coding experience.
2 years management experience preferred
Previous technical and supervisory experience in medical record/coding functions;
Previous revenue cycle experience.
Licensure and/or Certification:
Certified Coder Required, RHIA/RHIT certification preferred.
Knowledge and Skills
Extensive knowledge of medical terminology, anatomy and physiology, and disease processes.
Broad knowledge of Federal, State and payer-specific regulations and policies pertaining to documentation, coding and billing.
Ability to read and interpret regulatory guidelines with regard to proper coding and documentation.
Strong computer skills to include MS Office tools (Word, Excel, PowerPoint, and Outlook); previous 3M Encoder and Meditech experience preferred. Extensive use of computer and office equipment including fax, copy machines, scanners.
Technical skills to work with detailed systems, computer applications and intradepartmental units
Knowledge of JCAHO requirements and federal and state guidelines applicable to health record completeness and patient privacy.
Knowledge of health information systems and data management
Knowledge of health record content and sequence.
Strong analytical and communications skills; detailed oriented.
Ability to use judgment in carrying out all phases of the work.
Ability to accept constructive analysis based on feedback from inside/outside auditors, and quality improvement initiatives
Ability to maintain confidentiality with regard to all phases of the work.
Ability to be courteous, tactful, and cooperative throughout the working day.
Ability to process and provide accurate paperwork.
Ability to process work within presented deadlines and time frames.
Ability to manage multiple projects and large amounts of data.
Ability to work independently as well as a team player.
Demonstrated interpersonal and communications skills to ensure effective outcomes in dealing with the medical staff and other hospital employees.
Subject to irregular hours occasionally.