Inpatient DRG Coding Auditor

Emory Healthcare•Tucker, GA

5d•$39 - $48

About The Position

We are seeking an experienced Inpatient DRG Coding Auditor to extract data from patient encounters ensuring the accuracy of DRGs. This individual will review inpatient medical records for select payer populations post-discharge and pre-bill; audit the accuracy and completeness of diagnosis and procedure coding, DRG assignment, and abstracted data POA, Discharge Disposition. They will review discrepancies between the Clinical Documentation Specialist (CDS) DRG and the Coder DRG, and review non-CC/MCC records to determine if record was miscoded or if additional documentation is needed. This role works with Coders and CDSs to draft and initiate physician queries, performs reviews in a timely manner to maintain DNFB target of 4 days, and provides Coding development with coordination of educational and training programs regarding technical coding and clinical topics for the coding staff. Additionally, this role coordinates remediation when required, and coordinates with the Coding leadership, Quality nurses and the CDS team to educate physicians, nursing, and other clinical staff to improve documentation. The auditor will also review DRG Reassignment letters and assist in formulating Appeal letters.

Requirements

Certified Coding Specialist (CCS) certification.
Minimum five (5) years experience with coding ICD-10 in an acute care setting.
Previous experience in performing DRG coding audits.
Possesses knowledge of DRG and grouping methodologies (MS DRG's and AP DRG's); in particular what diagnoses / procedures impact DRG assignment.
Basic computer skills in word processing and spreadsheet utilization.
Excellent interpersonal skills to develop relationships necessary to facilitate and educate.
Excellent prioritization and organizational skills.

Nice To Haves

RHIA/RHIT preferred.

Responsibilities

Reviews inpatient medical records for select payer populations post-discharge and pre-bill; audits the accuracy and completeness of diagnosis and procedure coding, DRG assignment, and abstracted data POA, Discharge Disposition.
Reviews discrepancies between the Clinical Documentation Specialist (CDS) DRG and the Coder DRG.
Reviews non-CC/MCC records to determine if record was miscoded or if additional documentation is needed.
Works with Coders and CDSs to draft and initiate physician queries.
Performs reviews in a timely manner to maintain DNFB target of 4 days.
Provides Coding development with coordination of educational and training programs regarding technical coding and clinical topics for the coding staff.
Coordinates remediation when required.
Coordinates with the Coding leadership, Quality nurses and the CDS team to educate physicians, nursing, and other clinical staff to improve documentation.
Review¿s DRG Reassignment letters and assists in formulating Appeal letters