Drg Validation Auditor

Role and Responsibilities  Non è sicuro/a delle competenze necessarie per questa opportunità? Legga la descrizione completa qui sotto per avere un quadro completo dei requisiti richiesti.
The DRG Validation Auditor is a valued member of the Penstock Audit team, responsible for reviewing inpatient claims and ensuring that the DRG paid is fair and accurate, based on the documentation in the medical record and the application of ICD-10-CM and ICD-10-PCS coding conventions, instructions, guidelines, policies, and Coding Clinic advice. The DRG Validation Auditor upholds the standards of honesty, excellence, and innovation that are central to the Penstock mission.
Conducts thorough, thoughtful reviews of healthcare claims and medical records to identify discrepancies between the physician documentation, the clinical picture depicted in the record, the codes billed, and the resulting DRG

Appropriately uses industry-recognized references to support review findings, including the ICD-10-CM and ICD-10-PCS Official Guidelines for Coding and Reporting, AHIMA Standards of Ethical Coding, AHIMA Practice Briefs related to compliant querying, and AHA Coding Clinics

Writes complete, clear, and accurate rationale to support audit determinations, citing specific information from the record, and referencing appropriate guidelines, policies, regulations, and/or Coding advice

Keeps abreast of coding, clinical, regulatory, and other industry changes that impact Penstock auditing and/or that suggest new audit opportunities

Maintains focus on the identification and development of new audit concepts

Continuously considers the systems and processes involved with healthcare reimbursement (both internal and external) and communicates ideas for improvement through appropriate channels

Participates in focused training to learn new auditing skills across a myriad of clinical and coding scenarios

Communicates kindly, professionally, and effectively with all customers, both internal and external, and refers issues to management as appropriate

Continuously strives to find new avenues for fulfilling the Penstock mission of reclaiming greater integrity between payors and providers

Serves as a Payment Integrity subject matter expert for Penstock team members and for the Goodroot organization as a whole

Meets or exceeds Penstock’s performance and quality standards.

Senior Auditor positions provide support for Team Lead as required.

Qualifications and Education Requirements   Minimum of an associate degree

Current AHIMA Health Information Management credential(s): RHIT or RHIA

Current AHIMA/AAPC Coding Credential: CCS or CIC

Current Clinical Validation credential(s): CDIP, CCDS, or CDEI

3 or more years of ICD-10 inpatient coding experience

1 or more years of clinical experience in a healthcare facility setting

3 or more years of auditing experience (or demonstrated equivalent)

1 or more years of auditing experience in a payor setting

1 or more years of experience in Inpatient Rehabilitation coding/auditing

1 or more years of experience in Inpatient Psychiatric coding/auditing

Comprehensive understanding of ICD-10-CM Inpatient Coding Guidelines, AHA Coding Clinic, and DRG grouping mechanics

Strong current clinical knowledgebase

Familiarity with Clinical Documentation Integrity practices

Awareness of and adherence to HIPAA, and all laws regarding the safeguarding of PHI/PII

Ability to conduct independent research using credible sources

Demonstrated working knowledge of Microsoft Word, Excel, and Power Point

Ability to apply critical thinking skills to record reviews

Ability to work independently, manage workload, and adapt to shifting priorities

Willingness to adapt and learn new auditing skills across a myriad of coding and clinical scenarios

Excellent…