divh2Inpatient/DRG Validation Coding Auditor/h2pThe Inpatient/DRG Validation Coding Auditor performs documentation and coding audits for all acute inpatient services for clients. Identifies coding errors, compliance, and educational opportunities, and optimizes reimbursement by ensuring that the diagnosis/procedure codes and supporting documentation accurately support the services rendered and comply with ethical coding standards/guidelines and regulatory requirements. Performs independent reviews, interprets medical records, and applies in-depth knowledge of coding principles to determine billing/coding/documentation issues and quality concerns. Demonstrates high level of expertise in researching requirements necessary to make compliant recommendations./ppHas an extensive understanding of reimbursement guidelines, specifically related to DRG (MS, APR, Tricare, etc.) payment systems./ppConducts DRG (ex. MS, APR, Tricare) coding and clinical reviews to verify the accuracy of coding, DRG assignment and clinical indicators in accordance with coding and documentation guidelines. Ensures that the assigned DRG reflects the severity of the patients condition, and the resources used during their hospital stay./ppAssesses whether the clinical documentation supports the coded diagnoses and procedures. Verifies that the medical record adequately justifies the assigned DRG./ppCombines medical record coding guidelines, clinical principles, and industry trends to explain any recommended changes needed by coders. Works closely with CDI (Clinical Documentation Integrity) specialists to determine if there are documentation and/or query opportunities./ppMaintains productivity and quality goals as set by audit leaders./ppWrites clear, accurate and concise recommendations in support of findings while providing feedback and education to acute inpatient coders, referencing current ICD-10-CM/PCS Official Coding Guidelines and AHA Coding Clinics./ppEnsures acute inpatient coding audits are completed accurately and timely by meeting client turn around and audit quality expectations./ppResponsible for maintaining current certification(s), CEUs, and up-to-date knowledge of coding guidelines./ppCompletes required education through internal application, compliance training and other mandatory educational requirements./ppUse proprietary systems and encoder tools efficiently and accurately to make audit determinations, generate audit recommendations through workflow processes accurately./ppIdentifies any potential overpayments or underpayments by analyzing claims, on a 30-day lookback, to identify any discrepancies between billed DRGs and the actual services provided./ppLeverages ICD-10 coding expertise, clinical guidelines, and proprietary tools to substantiate conclusions. Continues to stay informed about changes in acute inpatient coding regulations and reimbursement policies./ppIdentifies potential opportunities, outside of the normal scope, where there may be additional recoveries or compliance concerns. Shares and assists in development of concepts and or process improvement, tools, etc./ppExperience We Love:/pulli5+ years of coding experience./lili3+ years of facility coding audit experience (such as DRG and APC Validation)./liliProficiency in multiple EMRs, encoders, and the Microsoft Office suite./liliEducated in HIPAA regulations; must maintain strict confidentiality of patient and client information./liliConsistently achieves quality and productivity standards./liliAbility to organize and complete work in a timely manner./liliAbility to read, write and effectively communicate in English./liliAbility to understand medical/surgical terminology./liliAbove average written and verbal communication skills./li/ulpMinimum Education:/pulliBachelors Degree or Equivalent Experience/li/ulpCertification Required:/ppCandidates must have and keep current at least one of the following professional certifications (CCS Preferred):/pulliCPC (Certified Professional Coder)/liliCCS (Certified Coding Specialist)/liliRHIA (Registered Health Information Administrator)/liliRHIT (Registered Health Information Technician)/li/ul/div