DRG Revenue Integrity Auditor

CorroHealth•Plano, TX

21h•Remote

About The Position

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. JOB SUMMARY: The DRG Revenue Integrity Auditor (DRG - A) performs Diagnostic Related Group (DRG) validation and quality audits on Inpatient charts. The DRG - A will perform chart reviews and will ensure that all reviewed charts capture the patient’s true clinical picture from the codes assigned by the facility’s coders in compliance with federal laws. The DRG - A will utilize International Classification of Diseases - Clinical Modification (CM) and Procedure Coding System (PCS) Terminology to ensure accurate coding. Responsible for validating proper sequencing and accuracy of ICD-10-CM/PCS codes, POA assignments, severity of illness (SOI), risk of mortality (ROM), Hierarchical Condition Category (HCC) capture CMI and other coding factors. Usage of most current Clinical Criteria, MCG, InterQual, payers’ Clinical Policy Bulletins, CMS Guidelines, NCDs and/or LCDs. Adherence to all coding guidelines and CDI best practices, as endorsed by ACDIS and AHIMA, to determine correct coding that is clinically supported and composing and sending queries when necessary. Analyze records for potential query opportunities and appropriate code assignment along with correct code sequencing. Maintain quality of reviews by making sure the true clinical picture is captured timely. Staying up to date with medical and coding guidelines, along with advancements within their field. Support CorroHealth in developing accurate training materials. Provide training and shadowing to new hires. Assist CorroHealth with project data analysis, reporting, and feedback internally and externally to CorroHealth clients. Maintain professional etiquette. Ensures all PHI is appropriately stored and delivered to authorized individuals. Meets or exceeds production and quality metrics. Attend all mandatory meetings and trainings. Additionally, DRG - A may also be required to audit clients’ clinical documentation integrity (CDI) program to include query review, analysis of coding, and overall program accuracy. Responsible to keep up with your company and EMR access log ins and passwords. All other position related duties as delegated by management. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The list below is representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Requirements

CCS Required
Five or more years working in an acute care setting or a third-party vendor as a DRG Auditor or Clinical Documentation Specialist (CDS).
Experience with telecommuting and electronic medical record systems required
Good computer skills and familiarity with commonly used work apps, such as MS Word, MS Excel, MS Outlook, Teams, etc.
Strong analytical skills
Works well with numbers, using basic math skills
Strong team player
Ability to work with multiple and diverse clients and projects
Ability to switch between multiple clients throughout the day and week
Ability to work with minimal supervision
Ability to maintain and access multiple files

Nice To Haves

Prior experience of working as a CDI/Coding auditor is preferred but NOT a requirement.

Responsibilities

Adherence to all coding guidelines and CDI best practices, as endorsed by ACDIS and AHIMA, to determine correct coding that is clinically supported
Analyze records for potential query opportunities and appropriate code assignment and code sequencing
Maintain quality of reviews and making sure the true clinical picture is captured, along with ensuring chart review productivity
Staying up to date with official coding guidelines, coding clinics and clinical criteria
Available to provide training to other new hires, if required, along with supporting development of training materials, as well as clinical, coding and CDI policies
Assisting with project data analysis, reporting, and feedback both internally and to clients
In all situations, protecting the privacy and confidentiality of patient health and client information, and follows the Standards of Ethical Coding as set forth by AHIMA and adheres to official coding guidelines and compliance practices, standards, and procedures
Conduct chart reviews as assigned, meeting the productivity standards as set forth for each project or record type
Communicates with coworkers in an open and respectful manner that promotes teamwork and knowledge sharing
When interacting with clients, always conducts themselves in a professional manner, exhibiting excellent relationship, work performance and communication skill so as to support the company and its business interests
Maintenance of professional credentials and knowledge of CDI, coding, reimbursement, and compliance issues through continuing education
Other duties and responsibilities, as assigned