DRG Integrity Specialist

Accuity; United States; Hybrid; USD 70,000 - 97,000; Full time

Job summary

Accuity is seeking a DRG Integrity Specialist to perform secondary reviews of medical records and code assignments with physicians, ensuring DRG accuracy under federal and client guidelines. The role supports reimbursement and requires strong knowledge of DRG systems and coding compliance.

The candidate will work with Accuity physicians and management, supervise coding quality, and provide education on compliant coding practices. Remote or on-site work arrangements are possible.

Qualifications

• Inpatient hospital coding experience required (min 4 years).
• DRG knowledge (MS-DRG, APR-DRG) required.
• AHIMA/AAPC coding credential required.
• Ability to work remotely or on-site.
• Strong auditing and compliance knowledge.

Responsibilities

• Review pre-bill cases with a physician to analyze and validate diagnosis and procedure codes for inpatient services to support accurate DRG assignment.
• Utilize Accuity technology to track coding errors and opportunities for improvement.
• Research and respond to inquiries regarding compliance, inappropriate coding, and client denials.
• Maintain dependability to meet coding recommendations, accuracy rates, and production standards.
• Interact with Accuity physicians, peers, CDIS, and management on documentation, policies, 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 and regulatory provisions.
• Attend in-house training for updated coding information and changes in regulations.
• Maintain strict confidentiality of patient medical records.
• Code medical records as needed based on organizational needs.
• Perform miscellaneous duties as assigned.

Skills

Inpatient coding

DRG reimbursement

Auditing concepts

Coding guidelines

MS Word

Communication skills

Regulatory compliance

Independent work

Education

High School Diploma or GED

Associate degree in HIM

Tools

AHIMA/AAPC credentials

EMR systems

Job description

Position Summary

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 requires a broad knowledge of the compliance structure to support the appropriate reimbursement.

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 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 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 needed
• Researches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, and client denials
• Possesses a high level of dependability and ability to meet Accuity coding recommendations, accuracy rate, and production standards
• Interacts with Accuity physicians, peers, CDIS, and management regarding documentation, 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 Accuity methodology
• Creates and provides group education and training based on accurate coding practices, coding compliance documentation, and regulatory provisions
• Attends in-house training sessions 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 medical records
• Always acts in an ethical and collaborative manner while monitoring own 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 GED required
• Associates Degree in Health Information Management or similar preferred

Experience

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

Licensure And/or Credentials

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

Knowledge, Skills, And Abilities

• Knowledge of auditing concepts and principles
• Expert of coding guidelines Ability 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 communication and 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 and procedure code 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.

While this job description is intended to be an accurate reflection of the job requirements, management reserves the right to modify, add or remove duties from a job and to assign other duties as necessary and at any time. All positions at Accuity are at-will employment, and a position description is not a guarantee of a job or of job responsibilities.