As a valued member of the DRG Review Team, the DRG Integrity Specialist performs a secondary level review of medical records and code assignment using knowledge of Accuity technology and client systems with a physician in accordance with federal coding regulations and guidelines as well as client specific coding guidelines to ensure accurate DRG assignment. This function

Assess the clinical indicators and suggestions of various query requests received from the MD Reviewer/ DRG Integrity Specialist Collaborate and communicate as necessary to clarify and avoid misinterpretation to ensure the query is optimally written and distributed to the correct client provider Creates queries in a compliant manner in accordance with AHIMA and ACDIS comp

Provides education to medical providers as warranted. Description What You'll Do Communicates/educates providers on issues such as Medicare coverage, utilization statistics, documentation and medical review by use of written advisories, reports, letters, and telephone contacts. Documents all provider contacts/communications in provider tracking system. Conducts formal con

Assists with the development of education and training of physicians, coders, and CDI specialists for Accuity Healthcare and provides coding component to all education programing, which may include preparation of related educational materials and giving frequent presentations on site and virtual Assists with the orientation programs and online learning module assignments

Review pre bill cases simultaneously with a physician during each work shift excluding breaks and meetings to analyze and validate diagnosis and procedure codes for inpatient services via coding compliance and clinical knowledge to support accurate DRG assignment Utilizes Accuity technology for tracking of coding errors, query opportunities and other data collection as ne

Assess the clinical indicators and suggestions of various query requests received from the MD Reviewer/ DRG Integrity Specialist Collaborate and communicate as necessary to clarify and avoid misinterpretation to ensure the query is optimally written and distributed to the correct client provider Creates queries in a compliant manner in accordance with AHIMA and ACDIS comp

Develops curriculum and materials for documentation training programs. Assesses coder comprehension. Conducts quality assurance reviews. Reviews, researches, and responds to coding questions. Resolves coding questions from patient inquiries or denied services from insurance companies. Performs focused quality assurance reviews on coded services. Communicates updates on co

Utilizes technical coding expertise to reviews the medical record thoroughly, utilizing all available documentation abstract and code physician professional services and diagnosis codes (including anesthesia encounters, operative room and surgical procedural services, invasive procedures and/or drug infusion encounters). Additionally, may include coding for Evaluation and

Utilizes technical coding expertise to reviews the medical record thoroughly, utilizing all available documentation abstract and code physician professional services and diagnosis codes (including anesthesia encounters, operative room and surgical procedural services, invasive procedures and/or drug infusion encounters). Additionally, may include coding for Evaluation and

Utilizes technical coding expertise to reviews the medical record thoroughly, utilizing all available documentation abstract and code physician professional services and diagnosis codes (including anesthesia encounters, operative room and surgical procedural services, invasive procedures and/or drug infusion encounters). Additionally, may include coding for Evaluation and

Quality Assurance Ensures the quality of billing information by verifying the completeness and accuracy of supporting documentation prior to submission of charges for reimbursement. Accesses patient records in multiple software systems, research conflicting information and facilitate the procurement of appropriate documentation to update UPAH records to support reimbursem

Utilizes technical coding expertise to reviews the medical record thoroughly, utilizing all available documentation abstract and code physician professional services and diagnosis codes (including anesthesia encounters, operative room and surgical procedural services, invasive procedures and/or drug infusion encounters). Additionally, may include coding for Evaluation and

Utilizes technical coding expertise to assign appropriate ICD 10 CM and ICD 10 PCS codes to acute rehab cases and inpatient OB and Newborn discharges. Complexity is measured by a Case Mix Index (CMI) and IP Coder Associate's typically see average CMI's of 0.5759 with the OB and Newborn population. This index score demonstrates lower patient complexity and acuity. Utilizes

Utilizes technical coding expertise to assign appropriate ICD 10 CM and ICD 10 PCS codes to complex inpatient visit types. Complexity is measured by a Case Mix Index (CMI) and Coder II's typically see average CMI's of 2.2609. This index score demonstrates higher patient complexity and acuity. Utilizes expertise in clinical disease process and documentation, to assign Pres

Assigns appropriately sequenced and compliant ICD 10 CM/PCS codes as documented in the electronic medical record (EMR). Applies definition of principal diagnosis for proper assignment of MS DRGs, APR DRGs, and POA indicators using a designated encoder/grouper, while ensuring compliance with nationally established coding guidelines. Utilizes selected encoder and/or compute