Drg Compliance Auditor; Dca

Review and check certain inpatient records to make sure the coding is correct and follows rules for ICD-10 codes. This includes checking the DRG groups, Present on Admission indicators, Severity of Illness, Risk of Mortality, Hospital-Acquired Conditions, and Patient Safety Indicators according to guidelines set by the Centers for Medicare & Medicaid Services and the American Hospital Association. Provide ongoing feedback and training to the staff in the Coding unit.

• Excellent customer service when working with Coding/CDI staff, clinicians, and other Michigan Medicine employees.
• Strong knowledge of ICD-10 coding and understand the Official Coding Guidelines well.
• Ability to review clinical documents to decide what information is needed for accurate DRG, POA, SOI, and ROM scores.
• Communicate effectively with the Coding/CDI team to ensure good outcomes.
• Write appropriate questions to the clinical care team following AHIMA Query Policy.
• Skilled in writing appeal letters to third-party payers to support DRG denials.
• Attention to detail to perform tasks with accuracy.
• Able to work independently, be self‑motivated, and adapt to changes in healthcare.
• Excellent verbal and written communication skills, with strong analytical thinking and problem‑solving abilities.
• Strong organizational skills and the ability to manage multiple tasks in a fast‑paced environment.
• Proficiency in using computers, including database and spreadsheet analysis, presentation software, word processing, and internet searches.
• Able to navigate the Electronic Health Record (EHR) to find and review necessary documents accurately.
• Experience using Michigan Medicine information systems/applications is preferred.

• Review a selection of Coding work to ensure accuracy and identify missed query opportunities.
• Give regular feedback to Coding staff to help them improve the accuracy of their work, reflecting the complexity of patient care and hospital reimbursements.
• Continuously check the quality of clinical documentation to find incomplete or inconsistent records and create training programs as needed.
• Develop and coordinate training programs on coding compliance, including proper documentation, accurate coding, trends found in chart reviews, audit findings, and regular coding updates.
• Identify and address missed query opportunities for Coding/CDI staff.
• Train new Coding staff on proper coding procedures.
• Review and provide documentation to support appeals for DRG denials from third‑party payers to prevent financial loss.
• Implement corrective action plans and educational programs to prevent future denials and rejections, including writing letters to the AHA and CMS for coding advice and recommendations.
• Suggest changes to ICD-10 codes by writing recommendations to the AHA.
• Conduct chart reviews and respond to coding requests from UMHS staff.
• Review updates in Coding Clinics and the Federal Register and share these updates with the team.
• Troubleshoot and resolve MiChart billing issues related to inpatient coding.
• Check clinical documentation for signs, symptoms, lab results, diagnostic info, and treatment plans to create appropriate queries for clinicians.
• Use 3M 360 Code Audit and Prebill tools during audits to ensure accurate data reporting.
• Support changes in documentation processes, like improving EHR data capture or redesigning templates.
• Identify documentation trends to be shared with clinical services and physician advisors for clinician education.
• Prepare specific documentation examples and PowerPoint presentations for clinical teams and departments.
• Stay updated with the processes, tools, and applications needed for job functions.
• Participate in the Michigan Quality System/Continuous Quality Improvement initiatives and apply Lean Thinking concepts to daily tasks.
• Show initiative by continuously learning new information and skills.
• Attend and participate in department activities, including staff meetings and training sessions.
• Perform other tasks as assigned to help keep the department running smoothly.

• Registered Health Information Technologist or Administrator (RHIT/RHIA) or CCS with Associate's…