DRG Revenue Integrity Auditor

CorroHealth•TX-Remote, TX

1d•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. 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.

Requirements

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.
Regular eye-hand coordination and manual dexterity is required to operate office equipment.
Ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required.
Ability to maintain and access multiple files.
Ability to maintain professional credentials and knowledge of CDI, coding, reimbursement, and compliance issues through continuing education.

Nice To Haves

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

Responsibilities

Performs Diagnostic Related Group (DRG) validation and quality audits on Inpatient charts.
Performs chart reviews to 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.
Utilizes International Classification of Diseases - Clinical Modification (CM) and Procedure Coding System (PCS) Terminology to ensure accurate coding.
Validates 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.
Utilizes current Clinical Criteria, MCG, InterQual, payers’ Clinical Policy Bulletins, CMS Guidelines, NCDs and/or LCDs.
Adheres to all coding guidelines and CDI best practices, as endorsed by ACDIS and AHIMA, to determine correct coding that is clinically supported.
Composes and sends queries when necessary.
Analyzes records for potential query opportunities and appropriate code assignment along with correct code sequencing.
Maintains quality of reviews by making sure the true clinical picture is captured timely.
Stays up to date with medical and coding guidelines, along with advancements within their field.
Supports CorroHealth in developing accurate training materials.
Provides training and shadowing to new hires.
Assists CorroHealth with project data analysis, reporting, and feedback internally and externally to CorroHealth clients.
Maintains professional etiquette.
Ensures all PHI is appropriately stored and delivered to authorized individuals.
Meets or exceeds production and quality metrics.
Attends all mandatory meetings and trainings.
May also be required to audit clients’ clinical documentation integrity (CDI) program to include query review, analysis of coding, and overall program accuracy.
Keeps up with company and EMR access log ins and passwords.
Performs other position related duties as delegated by management.
Conducts 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.
Conducts themselves in a professional manner when interacting with clients, exhibiting excellent relationship, work performance and communication skill so as to support the company and its business interests.
Maintains professional credentials and knowledge of CDI, coding, reimbursement, and compliance issues through continuing education.