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Audits the accuracy and completeness of diagnosis and procedure coding, DRG assignment, and abstracted data - POA, Discharge Disposition -- to support that appropriate reimbursement and clinical severity is captured for the level of service rendered Provides ongoing education to coders, physicians, and other clinical staff. Serves in an advisory and educator role for coding and regulatory compliance. Works effectively with the Coding Manager to improve coding services provided by the coding staff.
1. Reviews inpatient medical records for select payer populations post-discharge and pre-bill; audits the accuracy and completeness of diagnosis and procedure coding, DRG assignment, and abstracted data - POA, Discharge Disposition
2. Reviews discrepancies between the Clinical Documentation Specialist (CDS) DRG and the Coder DRG.
3. Reviews non-CC/MCC records to determine if record was miscoded or if additional documentation is needed.
4. Works with coders and CDS's to draft and initiate physician queries.
5. Performs reviews in a timely manner to maintain DNFB target of 5 days.
6. Develops and coordinates educational and training programs regarding technical coding and clinical topics for the coding staff.
7. Develops and implements education of physician, nursing, and other clinical staff to improve documentation to yield better coding.
1. Certified Coding Specialist (CCS) certification. RHIA/RHIT preferred.
2. Minimum five (5) years experience with coding ICD9.
3. Previous experience in performing DRG coding audits.
4. Possesses knowledge of DRG and grouping methodologies; in particular what diagnoses / procedures impact DRG assignment.
5. Basic computer skills in word processing and spreadsheet utilization
6. Excellent interpersonal skills to develop relationships necessary to facilitate and educate
7. Excellent prioritization and organizational skills.