Job Summary The DRG Auditor is responsible for performing an in-depth review of select inpatient medical records to ensure that the assigned codes and DRG are supported by clinical documentation and all diagnoses and procedures are coded with the required specificity and the discharge disposition and the POA are correct Knowledge of IPPS methodology is required. Responsible for mentoring and training other coders. Provide ongoing feedback and education to coding staff and Clinical Documentation Specialists.
Responsible for researching new technology for accurate code assignment. Assign and sequence ICD-10-CM, ICD-10-PCS, CPT and HCPCs diagnostic and procedural codes for all inpatient records for data retrieval, billing, and reimbursement. Perform documentation assessment and review for accurate abstracting of clinical data to meet regulatory and compliance requirements. Assist management with assigned special projects.
Assigns and sequences ICD-10-CM, ICD-10/-PCS, CPT and HCPCs diagnostic and procedural codes for inpatient and/or outpatient accounts within HonorHealth. Reviews physician documentation & coding for appropriateness & accuracy and makes corrections following Medicare & AMA coding guidelines. Assigns DRG and performs DRG validation as applicable. Reviews and provides coding guidance to coding staff. Utilizes electronic medical record and computer-assisted coding (CAC) software. Addresses NCCI, OCE, LCD, and other applicable coding edits.
Complies with system-wide coding practices to meet corporate compliance guidelines and to ensure appropriate and effective reimbursement with Patient Financial Services, medical staff and various departments. Reviews and analyzes medical records for accurate ICD and CPT code selection.
Mentors and educates coding staff and providers to ensure timely notification of identified trends that might impact revenue or compliance. Educates assigned providers on appropriate coding and documentation and provide supporting documentation to enhance awareness and corrections needed for accurate coding.
Participates in special projects involving coding, payer testing, and other project that interface with coding. Assists Patient Financial Services with interpretation and selection of appropriate ICD/CPT codes and /or other information requested for accurate billing and reimbursement. Possesses knowledge and understanding of failed bill parameters.
Performs charge reconciliation to ensure all submitted charges are posted timely and balance with total submitted charges. Assigns charges as applicable.
Communicates with hospital and outside agencies to reconcile issues affecting the coding department, including denials, coding errors, guideline clarifications, and technical issues. Addresses coding questions from coders and other entities. Resolves coding issues/problems and appropriately seeks assistance from Coding Supervisor.
Creates and updates information in shared coding drive as applicable, and communicates updates/change to applicable staff. Participates in continuing education activities to enhance knowledge, skills and keep credentials current in order to maintain skill set for outpatient coding.
Internal Number: 2018-13022
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We are a non-profit, local healthcare organization known for community service and outstanding medical quality. Our organization encompasses five acute care hospitals with approximately 10,500 employees and 3,100 volunteers, urgent care centers, clinical research, medical education, an inpatient rehabilitation hospital, an Accountable Care Organization, two foundations, and extensive community services.