DRG Validator - Full Time

SGHS•Brunswick, GA

5d•Onsite

About The Position

The DRG Validator ensures the accurate assignment of Diagnosis Related Groups (DRGs) for our patients and applies a thorough understanding of medical coding guidelines, clinical documentation, and reimbursement principles. All team members of Southeast Georgia Health System will promote a culture of safety, follow established policies, and adhere to all state and federal regulatory requirements, Joint Commission requirements, and national patient safety standards. For our team members, this is more than a career — it’s a calling.

Requirements

College Degree in Health Information Management or related field
5 years’ Inpatient coding experience
Credentialed coding professional, RHIA, RHIT, CCS, CPC CCS-P required

Responsibilities

Reviews medical records and clinical documentation to verify the accuracy of assigned DRGs to ensure the correct case mix is reflected for our Health System.
Analyzes patient charts to identify discrepancies or inconsistencies in DRG assignment.
Stays updated on changes in coding guidelines, regulations, and healthcare policies affecting DRG assignment
Demonstrates understanding of policies, procedures and federal guidelines that apply directly to coding, DRG assignment, reimbursement, clinical documentation improvement, and UB 04 standards.
Responsible for reviewing clinical documentation reviews performed for all inpatients prior to billing within the requirements of the Centers of Medicaid & Medicare Services and other regulatory agencies
Collaborates with coding and clinical staff to resolve coding-related issues.
Participates in coding audits and quality improvement initiatives.
Effectively communicates current and revised coding changes and clarifications to ancillary departments and Medical Staff members.
Works with Quality team as needed
Performs second review of focus DRG’s, discharge disposition, and Present on Admission flags of encounters prior to billing.