DRG Integrity Specialist

Position Summary: 

As a valued member of the DRG Review Team, 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 appropriate reimbursement.

Primary Job Responsibilities: 

Review pre-bill cases simultaneously with a physician 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 Accuity technology for tracking of coding errors, query opportunities and other data collection as needed

Researches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, and client denials

Possesses a high level of dependability and ability to meet Accuity coding recommendations, accuracy rate, and production standards 

Interacts with Accuity physicians, peers, CDIS, and management regarding documentation, policies, procedures, and regulations 

Interacts with management on an ongoing basis including assisting senior level staff in providing 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 Accuity 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 

Always acts in an ethical and collaborative manner while monitoring own work to help ensure quality 

Codes medical records as needed based on organizational needs 

Performs miscellaneous job-related duties as assigned 

Position Qualifications: 

Education: 

High School Diploma or GED required 

Associates Degree in Health Information Management or similar preferred  

Experience:

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)

Licensure and/or Credentials: 

Coding credential required from AHIMA/AAPC (RHIA, RHIT, CCS and/or CPC, or CIC)  

Knowledge, Skills, and Abilities:

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 

Strong 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 provide 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

Physical Requirements:

The requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job with or without reasonable accommodations.

Unless otherwise indicated, Accuity positions require interaction with people and technology while either sitting or standing. Employees must be able to communicate via phone, email, etc. and sit for extended periods of time, with or without reasonable accommodations. Physical effort and exposure to physical risk are limited to that of an office role environment.  

While this job description is intended to be an accurate reflection of the job requirements, management reserves the right to modify, add or remove duties from a job and to assign other duties as necessary and at any time. All positions at Accuity are at-will employment, and a position description is not a guarantee of a job or of job responsibilities.