HEALTH FIRST CAREERS
Inpatient DRG Auditor- Coding and Documentation
HEALTH FIRST CAREERS, Rockledge, Florida, United States, 32955
Job Requirements
POSITION SUMMARY
The Inpatient Diagnosis Related Group (DRG) Auditor performs inpatient DRG reviews, auditing for
coding and abstracting compliance and accuracy. The Inpatient DRG Auditor will collaboratively work
as a key member of the Coding and Documentation Services team.
PRIMARY ACCOUNTABILITES 1. Performs daily focus DRG prebill monitoring of accounts assigned and conducts inpatient coder
quality audits, reporting results to Coding Leadership monthly and always promoting a
collaborative effort to solve quality opportunities. 2. Facilitates probe and spot inpatient audits as requested by Leadership or outside departments. 3. Maintains a record of all inpatient audits performed to include, sample pull, audit results, rebuttal
process, corrections or rebills as necessary, educational action plan, and follow-up audit as
necessary. 4. Facilitates completion of the annual departmental inpatient audit plan components. 5. Executes and oversees reconciliation and follow-up of RAC and private insurance reviews of
potential DRG revision recommendations. 6. Reviews and validates assignment of ICD-10 diagnosis and procedure codes based upon
physician documentation in the medical record in accordance with coding and compliance
guidelines. 7. Verifies diagnosis, procedures, and DRG optimization and accuracy by utilizing the 3M Encoder
Analyzer tool as well as any other resources available, providing timely notification to medical
records and registration personnel of any identified discrepancies of patient information in the
medical record. 8. Enables DRG or code change recommendations from external entities communicating
appropriately and timely as per the appeal instructions. 9. Requests clarification from licensed practitioners when conflicting, incomplete, or ambiguous
information is found in the health record regarding a significant reportable condition or
procedure or other reportable data element. 10. Attends monthly department meetings and bi-monthly coding and Clinical Documentation
Improvement (CDI) roundtables, while staying abreast of new regulatory requirements,
revisions, updates, and DRG changes in the coding arena by education, research, and
networking. 11. Maintains and observes patient confidentiality as outlined in the National Patient Safety Goals
and Healthcare Information Portability HIPAA guidelines that protects the confidentiality of the
health record and refuses to access protected health information not required for
coding/auditing related activities.
Work Experience
MINIMUM QUALIFICATIONS Education:
High School diploma or equivalent. Work Experience:
Three (3) years inpatient coding experience. Licensure:
None Certification:
Any one of the following prior to start date and maintained: Certified Coding Specialist (CCS) OR Certified Inpatient Coder (CIC).
Work Experience In Lieu of Certification:
Additional seven (7) years' inpatient coding
experience attain a CCS or CIC certification within one (1) year from the date of start date. Skills/Knowledge/Abilities: Proficient in Microsoft Office - Outlook, Word, Excel, PowerPoint. Ability to work autonomously with minimal supervision. Excellent precise written and oral communication skills for professional interaction and presence. Excellent problem solving, analytical, and critical thinking skills. Demonstrate the highest standard of customer service skills. Ability to work well under time pressure meeting deadlines. Must be detail oriented. Ability to muti-task. Must be flexible, accountable, and dependable.
PREFERRED QUALIFICATIONS Work Experience: Five (5) years inpatient coding experience.
PHYSICAL REQUIREMENTS Majority of time involves sitting or standing; occasional walking, bending, and stooping. Long periods of computer time or at workstation. Light work that may include lifting or moving objects up to 20 pounds with or without assistance. May be exposed to inside environments with varied temperatures, air quality, lighting and/or low
to moderate noise. Communicating with others to exchange information. Visual acuity and hand-eye coordination to perform tasks. Workspace may vary from open to confined.
Benefits
ABOUT HEALTH FIRST
At Health First, diversity and inclusion are essential for our continued growth and evolution. Working together, we strive to build and nurture a culture that recognizes, encourages, and respects the diverse voices of our associates. We know through experience that different ideas, perspectives, and backgrounds create a stronger and more collaborative work environment that delivers better results. As an organization, it fuels our innovation and connects us closer to our associates, customers, and the communities we serve.
POSITION SUMMARY
The Inpatient Diagnosis Related Group (DRG) Auditor performs inpatient DRG reviews, auditing for
coding and abstracting compliance and accuracy. The Inpatient DRG Auditor will collaboratively work
as a key member of the Coding and Documentation Services team.
PRIMARY ACCOUNTABILITES 1. Performs daily focus DRG prebill monitoring of accounts assigned and conducts inpatient coder
quality audits, reporting results to Coding Leadership monthly and always promoting a
collaborative effort to solve quality opportunities. 2. Facilitates probe and spot inpatient audits as requested by Leadership or outside departments. 3. Maintains a record of all inpatient audits performed to include, sample pull, audit results, rebuttal
process, corrections or rebills as necessary, educational action plan, and follow-up audit as
necessary. 4. Facilitates completion of the annual departmental inpatient audit plan components. 5. Executes and oversees reconciliation and follow-up of RAC and private insurance reviews of
potential DRG revision recommendations. 6. Reviews and validates assignment of ICD-10 diagnosis and procedure codes based upon
physician documentation in the medical record in accordance with coding and compliance
guidelines. 7. Verifies diagnosis, procedures, and DRG optimization and accuracy by utilizing the 3M Encoder
Analyzer tool as well as any other resources available, providing timely notification to medical
records and registration personnel of any identified discrepancies of patient information in the
medical record. 8. Enables DRG or code change recommendations from external entities communicating
appropriately and timely as per the appeal instructions. 9. Requests clarification from licensed practitioners when conflicting, incomplete, or ambiguous
information is found in the health record regarding a significant reportable condition or
procedure or other reportable data element. 10. Attends monthly department meetings and bi-monthly coding and Clinical Documentation
Improvement (CDI) roundtables, while staying abreast of new regulatory requirements,
revisions, updates, and DRG changes in the coding arena by education, research, and
networking. 11. Maintains and observes patient confidentiality as outlined in the National Patient Safety Goals
and Healthcare Information Portability HIPAA guidelines that protects the confidentiality of the
health record and refuses to access protected health information not required for
coding/auditing related activities.
Work Experience
MINIMUM QUALIFICATIONS Education:
High School diploma or equivalent. Work Experience:
Three (3) years inpatient coding experience. Licensure:
None Certification:
Any one of the following prior to start date and maintained: Certified Coding Specialist (CCS) OR Certified Inpatient Coder (CIC).
Work Experience In Lieu of Certification:
Additional seven (7) years' inpatient coding
experience attain a CCS or CIC certification within one (1) year from the date of start date. Skills/Knowledge/Abilities: Proficient in Microsoft Office - Outlook, Word, Excel, PowerPoint. Ability to work autonomously with minimal supervision. Excellent precise written and oral communication skills for professional interaction and presence. Excellent problem solving, analytical, and critical thinking skills. Demonstrate the highest standard of customer service skills. Ability to work well under time pressure meeting deadlines. Must be detail oriented. Ability to muti-task. Must be flexible, accountable, and dependable.
PREFERRED QUALIFICATIONS Work Experience: Five (5) years inpatient coding experience.
PHYSICAL REQUIREMENTS Majority of time involves sitting or standing; occasional walking, bending, and stooping. Long periods of computer time or at workstation. Light work that may include lifting or moving objects up to 20 pounds with or without assistance. May be exposed to inside environments with varied temperatures, air quality, lighting and/or low
to moderate noise. Communicating with others to exchange information. Visual acuity and hand-eye coordination to perform tasks. Workspace may vary from open to confined.
Benefits
ABOUT HEALTH FIRST
At Health First, diversity and inclusion are essential for our continued growth and evolution. Working together, we strive to build and nurture a culture that recognizes, encourages, and respects the diverse voices of our associates. We know through experience that different ideas, perspectives, and backgrounds create a stronger and more collaborative work environment that delivers better results. As an organization, it fuels our innovation and connects us closer to our associates, customers, and the communities we serve.