DRG Revenue Integrity Auditor

JOB SUMMARY:

The DRG Revenue Integrity Auditor (DRG
- A) performs Diagnostic Related Group (DRG) validation and quality audits on Inpatient charts. The DRG - A will perform chart reviews and will ensure that all reviewed charts capture the patient’s true clinical picture from the codes assigned by the facility’s coders in compliance with federal laws. The DRG - A will utilize International Classification of Diseases - Clinical Modification (CM) and Procedure Coding System (PCS) Terminology to ensure accurate coding.

Responsible for validating proper sequencing and accuracy of ICD-10-CM/PCS codes, POA assignments, severity of illness (SOI), risk of mortality (ROM), Hierarchical Condition Category (HCC) capture CMI and other coding factors. Usage of most current Clinical Criteria, MCG, Inter Qual, payers’ Clinical Policy Bulletins, CMS Guidelines, NCDs and/or LCDs. Adherence to all coding guidelines and CDI best practices, as endorsed by ACDIS and AHIMA, to determine correct coding that is clinically supported and composing and sending queries when necessary.

Analyze records for potential query opportunities and appropriate code assignment along with correct code sequencing. Maintain quality of reviews by making sure the true clinical picture is captured timely. Staying up to date with medical and coding guidelines, along with advancements within their field. Support Corro Health in developing accurate training materials. Provide training and shadowing to new hires. Assist Corro Health with project data analysis, reporting, and feedback internally and externally to Corro Health clients.

Maintain professional etiquette. Ensures all PHI is appropriately stored and delivered to authorized individuals. Meets or exceeds production and quality metrics. Attend all mandatory meetings and trainings. Additionally, DRG - A may also be required to audit clients’ clinical documentation integrity (CDI) program to include query review, analysis of coding, and overall program accuracy. Responsible to keep up with your company and EMR access log ins and passwords.

All other position related duties as delegated by management. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The list below is representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Note:

The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

• Adherence to all coding guidelines and CDI best practices, as endorsed by ACDIS and AHIMA, to determine correct coding that is clinically supported
• Analyze records for potential query opportunities and appropriate code assignment and code sequencing
• Maintain quality of reviews and making sure the true clinical picture is captured, along with ensuring chart review productivity
• Staying up to date with official coding guidelines, coding clinics and clinical criteria
• Available to provide training to other new hires, if required, along with supporting development of training materials, as well as clinical, coding and CDI policies
• Assisting with project data analysis, reporting, and feedback both internally and to clients
• In all situations, protecting the privacy and confidentiality of patient health and client information, and follows the Standards of Ethical Coding as set forth by AHIMA and adheres to official coding guidelines and compliance practices, standards, and procedures
• Conduct chart reviews as assigned, meeting the productivity standards as set forth for each project or record type
• Communicates with coworkers in an open and respectful manner that promotes teamwork and knowledge…