Job Description

We are an academic acute care medical center and one of New York's premier academic health systems comprised of 10 hospitals and more than 200 outpatient ambulatory care sites. We are currently looking for a DRG Specialist for our growing HIM department who will provide expert level coding consultation and guidance for complex medical records that require research and interpretation of clinical documentation.

Position: DRG Specialist

Location: Remote (White Plains, NY area)

Salary: $100,000 - $125,000

Responsibilities:

• Implements and performs ongoing medical record reviews for records coded and conducts performance improvement activities regarding coding accuracy, auditing, data quality, and integrity
• Analyzes statistical data regarding coding trends, coding errors/edits, and coding denials and provides corrective in-service training sessions to address all coding issues at the root cause
• Serves as a project leader for projects related to quality of ICD-10 coding and evaluation of revenue impact; researches and advises HIM management regarding feasibility of coding products, educational tools, analyzes data to identify areas for improvement and integrity
• Respond to medical necessity and other coding edits and denials from internal and external review agencies
• Monitors and oversees the Pre-AR coding edit work queues, the coding claim edit work queues, and assists with coding denials as needed.
• Provides all levels of appeal to DRG based denials of payment and prepares documents for Administrative Law Judge as required to obtain payment; evaluates recommendations of external consultants on coding validation results.

Requirements:

• Bachelor’s degree in a health-related field or significant work experience appropriate to carry out the responsibilities of this position preferred.
• Expert clinical knowledge to analyze a medical record and prior clinical experience with a documentation improvement program is a plus.
• Certification by recognized national organization including: RHIA, RHIT, CCS, CPC Required.
• Knowledge of the elements of disease processes and related procedures.
• Ability to build effective partnering relationships with providers and other clinical staff, Finance and payer representatives to problem solve and improve quality.
• Knowledge of various DRG groupings and reimbursement methodologies with excellent critical thinking, analytical, verbal and written communication skills.
• Experience in writing denial appeals a plus.

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