The Provider Review Services Coordinator manages data transformation tasks and oversees the planning, preparation, and finalization of provider review projects. They are responsible for maintaining audit databases, managing client communication, and ensuring data integrity throughout the review process.
Collaborate with healthcare staff to improve the accuracy and specificity of clinical documentation. Review medical records to ensure appropriate DRG assignment and validity of severity of illness and risk of mortality.
The role involves performing compliance audits based on CMS, CPT, ICD-10 guidelines, and state/federal regulations, focusing on Evaluation and Management (E&M) reviews. Responsibilities include documenting findings, writing recommendation worksheets, and presenting educational feedback to clients during summation calls.
The consultant performs compliance audits of medical records against coding guidelines, writing concise recommendations and presenting findings to coders during education exits. Responsibilities also include reviewing documentation for accuracy, utilizing various coding software, running reports, and conducting exit conferences with administration and coding staff.
The specialist codes all requested Inpatient medical records using the most accurate ICD-10-CM/PCS and DRG assignment according to guidelines and policies. This includes abstracting key data elements required by UHDDS and maintaining specified productivity and accuracy standards.
