Senior Inpatient Coding & DRG Auditor

DME Service Solutions; Philippines; On-site; PHP 350,000 - 650,000; Full time

Job summary

DME Service Solutions in the Philippines seeks a Payment Integrity DRG Coding & Clinical Validation Analyst to review medical records, validate principal diagnosis, co-morbidities, and POA indicators to ensure accurate coding and DRG assignment.

The role requires extensive inpatient coding experience, knowledge of MS-DRG and APR-DRG, and the ability to work independently while adhering to coding guidelines and privacy policies.

Qualifications

• Degree in health information management (RHIA or RHIT) or a Nursing Degree.
• Three (3) years' experience in claims auditing, quality assurance, or recovery auditing of (MS/APR) DRG coding for hospital or other acute facility setting.
• Three (3) years of working experience with ICD 10CM, MS-DRG, and APR-DRG with a broad knowledge of medical claims billing/payment systems, provider billing guidelines, medical necessity criteria, and coding terminology.
• Coding Certification to be maintained as a condition of employment: RHIA or RHIT, Inpatient Coding Credential – CCS or CIC
• Intermediate analytical and problem-solving skills
• Keeps abreast of latest trends related to business analysis

Responsibilities

• Analyze and audit acute inpatient claims
• Review medical records and integrate medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities
• Draw on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions
• Perform work independently and adhere to official coding guidelines, coding clinic determinations, and CMS and other regulatory compliance guidelines and mandates
• Establish national and best practice benchmarks and measure performance against benchmarks
• Ensure accurate payment by independently utilizing DRG grouper, encoder, and claims processing platform
• Manage case volumes and review/audit schedules, prioritizing case load as assigned by management
• Maintain high regard for member privacy in accordance with corporate privacy policies and procedures

Skills

Analytical skills

Problem-solving skills

Business analysis awareness

Education

Bachelor's degree in Health Information Management or Nursing

Job description

DME Service Solutions in the Philippines seeks a Payment Integrity DRG Coding & Clinical Validation Analyst to review medical records, validate principal diagnosis, co-morbidities, and POA indicators to ensure accurate coding and DRG assignment.

The role requires extensive inpatient coding experience, knowledge of MS-DRG and APR-DRG, and the ability to work independently while adhering to coding guidelines and privacy policies.