DIAGNOSIS RELATED GROUP SPECIALIST (TARRYTOWN, NY, US)
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About The Position
The DRG Specialist provides expert level coding consultation and guidance for complex medical records that require research and interpretation of clinical documentation. This role serves as a project leader for projects related to the quality of ICD-10 coding and evaluation of revenue impact. The specialist researches and advises HIM management regarding the feasibility of coding products and educational tools, analyzes data to identify areas for improvement, and oversees the coding function in the absence of the manager. Additionally, the specialist assists in the orientation and education of the coding staff. The position also involves providing all levels of appeal to DRG-based denials of payment and preparing documents for Administrative Law Judge as required to obtain payment, as well as evaluating recommendations of external consultants on coding validation results. The specialist performs all duties of the Senior Medical Audit Analyst and related work as required.
