Clinical Reimbursement Manager; DRG Manager; Mount Sinai Hospital
About The Position
The purpose of DRG validation is to confirm that diagnostic, procedural information, and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician’s description and the information contained in the beneficiary’s medical record. Responsible for performing quality reviews of medical records to validate correctness and appropriateness of the assigned International Classification of Diseases, 10th Revision (ICD-10-CM and ICD-10-PCS) codes and the Diagnosis Related Groups (DRG). The CRM reviews the physician documentation for specificity, completeness and quality to support coding accuracy, and to identify physician query opportunities to improve the documentation. The CRM will follow the official coding rules, guidelines and conventions to validate coded data and ensure high quality and compliance with regulatory requirements. The CRM works in conjunction with the Associate Director and Director of DRG Validation to help develop coding education and training and institutional coding policies to achieve coding excellence.
Requirements
- Understanding of diagnostic, procedural information, and discharge status of the beneficiary.
- Ability to validate correctness and appropriateness of assigned ICD-10-CM and ICD-10-PCS codes and DRG.
- Skill in reviewing physician documentation for specificity, completeness, and quality.
- Knowledge of official coding rules, guidelines, and conventions.
- Ability to ensure high quality and compliance with regulatory requirements.
- Experience in developing coding education and training.
- Experience in developing institutional coding policies.
Responsibilities
- Performing quality reviews of medical records to validate correctness and appropriateness of the assigned International Classification of Diseases, 10th Revision (ICD-10-CM and ICD-10-PCS) codes and the Diagnosis Related Groups (DRG).
- Reviewing physician documentation for specificity, completeness and quality to support coding accuracy.
- Identifying physician query opportunities to improve the documentation.
- Following official coding rules, guidelines and conventions to validate coded data and ensure high quality and compliance with regulatory requirements.
- Working in conjunction with the Associate Director and Director of DRG Validation to help develop coding education and training and institutional coding policies to achieve coding excellence.
Benefits
- Strength through Unity and Inclusion
- Commitment to fostering an environment where everyone can contribute to excellence.
- Unparalleled legacy of achievement, education, and innovation.
- Opportunities for professional development and advancement.
- Commitment to creating a culture that ensures fair access to opportunities, promotes inclusive practices, and supports the success of every individual.
- Commitment to fostering a workplace where all employees feel valued, respected, and empowered to grow.
- Environment where collaboration, fairness, and continuous learning drive positive change.
- Supportive and welcoming environment where everyone has the opportunity to thrive and advance professionally.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
