The DRG Validation Auditor partners with medical directors to conduct pre-bill reviews and ensure accurate diagnosis and procedure coding for inpatient encounters. They are responsible for resolving coding compliance issues, tracking audit data, and providing education on coding best practices.
The Query Writer is responsible for drafting and managing compliant physician queries to ensure accurate clinical documentation and appropriate reimbursement. They collaborate with medical directors and coding teams to resolve documentation ambiguities and maintain compliance with AHIMA and ACDIS standards.
The Medical Director provides strategic oversight for clinical documentation and coding integrity to ensure accurate representation of patient acuity. They collaborate with internal teams to optimize quality metrics and provide education to physicians regarding documentation best practices.
