DRG Integrity Specialist

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.

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