DRG Integrity Specialist

Accuityhealthcare; Northern (KY); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Accuityhealthcare is seeking a DRG Integrity Specialist to perform secondary reviews of inpatient records, ensuring accurate DRG assignments through coding knowledge and adherence to federal regulations and client guidelines.

The role collaborates with physicians, CDIS, and management to improve processes, training, and coding accuracy while maintaining confidentiality and meeting deadlines. Remote or on-site work options are available.

Qualifications

• High school diploma or GED required.
• Associate degree in Health Information Management or similar preferred.
• Minimum 4 years inpatient coding experience in hospital facility coding.
• Minimum 2 years of related duties experience.
• Experience with DRG reimbursement (MS-DRG, APR-DRG).
• Coding credentials required (RHIA, RHIT, CCS, CPC, CIC).

Responsibilities

• Review pre-bill cases with a physician to validate diagnosis and procedure codes for inpatient services.
• Utilize Accuity technology to track coding errors and opportunities.
• Research, analyze, and respond to inquiries regarding compliance, inappropriate coding, and client denials.
• Meet coding recommendations, accuracy rate and production standards.
• Interact with Accuity physicians, peers, CDIS, and management on documentation and regulations.
• Assist senior staff with process improvement to meet productivity and quality goals.
• Review and adapt client procedures to align with Accuity methodology.
• Provide group education and training on accurate coding practices.
• Attend trainings to stay updated on coding information and regulatory changes.
• Maintain strict confidentiality of patient medical records.
• Codes medical records as needed and perform miscellaneous duties.

Skills

Auditing concepts

Independent judgment

Confidential handling

Medical coding knowledge

Communication skills

Regulatory compliance awareness

Problem solving

Windows OS

MS Word

Education

High School Diploma or GED

Associates Degree in Health Information Management

Tools

EMR systems

Windows OS

MS Word

Job description

Position Summary:

As a valued member of the DRG Review Team, the DRG Integrity Specialistperforms a secondary level review of medical records and code assignment using knowledge of Accuity technology and client systems with a physicianin accordance withfederal coding regulations and guidelines as well as client specific coding guidelines to ensureaccurateDRG assignment.This function requires a broad knowledge of the compliance structure to support the appropriate reimbursement.

Primary Job Responsibilities:

• Review pre-bill cases simultaneously with a physician during each work shift excluding breaks and meetings to analyze and validatediagnosis and procedure codes for inpatient services via coding compliance and clinical knowledge to supportaccurate DRG assignment
• Utilizes Accuity technology for tracking of coding errors, query opportunities and other data collection as needed
• Researches, analyzes, and responds to inquiries regardingcompliance, inappropriate coding,and clientdenials
• Possesses a high levelof dependability and ability to meet Accuitycodingrecommendations,accuracyrate,and production standards
• Interacts with Accuityphysicians, peers, CDIS, and managementregardingdocumentation, policies, procedures, and regulations
• Interacts with management on an ongoing basis including assisting senior level staff in providing recommendations for process improvement so that productivity and quality goals can be met or exceeded, and operational efficiency and financial accuracy can be achieved
• Reviews, develops, modifies, and/or adapts relevant client procedures, protocols, and systems to coordinate with Accuitymethodology
• Creates and provides group education and training based on accuratecoding practices,coding compliance documentation, andregulatory provisions
• Attends in-house trainingsessions to receive updated coding information and changes in coding and/or regulations
• Adheres to stringent timelines consistent with project deadlines and directives
• Ensures strict confidentiality of patient medicalrecords
• Always acts in an ethical and collaborative manner while monitoringown work to help ensure quality
• Codes medical records as needed based on organizational needs
• Performs miscellaneous job-related duties as assigned

Position Qualifications:

Education:

• High School Diploma or GEDrequired
• Associates Degree in Health Information Managementor similar preferred

Experience:

• Minimum 4 years of inpatient coding experience in hospital facility coding
• Minimum 2 years of experience that is directly relatedto the duties and responsibilities specified above
• Experience and knowledge in DRG reimbursement (i.e., MS-DRG, APR-DRG)

Licensureand/orCredentials:

• Coding credential required from AHIMA/AAPC (RHIA, RHIT, CCSand/or CPC, or CIC)

Knowledge, Skills, and Abilities:

• Knowledge of auditing concepts and principles
• Expert of coding guidelinesAbility to use independent judgment and to manage and impart confidential information
• Advanced knowledge of medical coding, electronic medical record systems, coding systems
• Critical thinking skills to analyze and solve problems
• Strong communicationand interpersonal skills
• Knowledge of legal, regulatory, and policy compliance issues related to medical coding and documentation
• Knowledge of current and developing issues and trends in medical coding diagnosis andprocedurecode assignment
• Ability to clearly communicate medical information to physicians and CDIS staff
• Ability to provide guidance and training to when needed
• Ability to use a PC in a Windows environment, including MS Word
• Independent, focused individual able to work remotely or on-site

Physical Requirements:

The requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job with or without reasonable accommodations.

Unless otherwise indicated, Accuity positions require interaction with people and technology while either sitting or standing. Employees must be able to communicate via phone, email, etc. and sit for extended periods of time, with or without reasonable accommodations. Physical effort and exposure to physical risk are limited to that of an office role environment.