Remote DRG Specialist: Inpatient Coding & Audits

UPMC; Pittsburgh (Allegheny County); On-site; USD 65,000 - 95,000; Full time

Job summary

UPMC Corporate Revenue Cycle is hiring a DRG Specialist to work on inpatient auditing within our Coding Department. This position will be a work-from-home role operating during standard business hours Monday through Friday.

In this role, you will review clinical documentation within the medical record to ensure that all patient resource utilization, diagnostic complications and co-morbidities have been coded in compliance with coding guidelines, third-party payer and OIG regulations.

Qualifications

• Knowledge of DRG coding and inpatient auditing.
• Experience with medical record review.
• Understanding of third-party payer and OIG regulations.

Responsibilities

• Review and evaluate DRG medical records for accurate DRG assignment and proper sequencing of diagnoses and procedures.
• Meet with coding management to review progress and support audits and projects.
• Investigate and address questions about discharge disposition, dates, or codes to ensure timely reimbursement.
• Support Medicare 72-Hour Rule compliance by coordinating with Admitting and Patient Business Services.
• Coordinate DRG reimbursement issues across coding, nursing, medical staff and other departments.
• Prepare monthly DRG revenue and productivity reports for management.

Skills

Clinical documentation review

DRG coding

Auditing

Compliance knowledge

Regulatory knowledge

Job description

UPMC Corporate Revenue Cycle is hiring a DRG Specialist to work on inpatient auditing within our Coding Department. This position will be a work-from-home role operating during standard business hours Monday through Friday.

In this role, you will review clinical documentation within the medical record to ensure that all patient resource utilization, diagnostic complications and co-morbidities have been coded in compliance with coding guidelines, third-party payer and OIG regulations.