DRG Validator
Mount Auburn Hospital - Cambridge, MA

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Under the direction of the Director of HIM, validates ICD-9-CM and CPT coding and DRG assignments to ensure consistency and efficiency in claims processing, data collection, and quality reporting for Mount Auburn Hospital.

1.Performs quality reviews of records coded by the department coding staff; provides daily feedback to coders on the need for complete and accurate coding for reimbursement, quality reporting, research, and planning.

2. Validates DRG assignment, with focus on the distinguishing characteristics of each grouper, including MS-DRG, APR-DRG, Psych DRG, and APC.

3. Performs reviews of data abstraction by coders, ensuring the data elements that need to be included are present.

4. Tracks completion of coding done in the department to assure that filing limits are met and deadlines for submission of data to the state and to the Department of Quality and Safety are met.

5. Assures correct coding of inpatient and outpatient episodes through communication with the coders, assuring enough specificity to clearly reflect the patients’ conditions and resulting in optimal case mix index and fair reimbursement.

6. Keeps abreast of regulatory and reimbursement changes. Identifies and reviews the complications and co-morbidities of each grouper with the coders, pointing out the differences in each.

7. Tracks error rates in coding and in abstracting of each department coder.

8. Creates appeals to DRG validators on changes in coding, reviewing denials and appealing when appropriate. Assist third party auditors in responding to questions in billing and documentation issues.

9. Maintain logs of appeals and denials of DRG assignment by outside auditors.

10.Reinforces the need to safeguard the privacy of health information in the medical record.

11.Attends meetings and educational conferences, assuming personal responsibility for professional development and ongoing education to maintain proficiency.

12. Adheres to and enlarges upon coding policies and procedures in accordance with AHIMA’s Code of Ethical Conduct and AHIMA’s Standards of Ethical Coding.

JOB REQUIREMENTS:
KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED 1. RHIA or RHIT with CCS certification preferred with five years’ experience in coding at acute care teaching hospital. 2. In depth knowledge of coding/classification systems appropriate for inpatient and outpatient payment systems. 3. General knowledge of hospital information systems as well as knowledge of computer applications used in Health Information, such as Excel and Word. 4. Knowledge of Joint Commission requirements and federal and state guidelines applicable to health record completeness and patient privacy rights. 5. Ability to perform under significant levels of on-going pressure, ability to deal with physicians and others with tact, discretion, and diplomacy. 6. Demonstrated skills in interpersonal relationships and in oral and written communication. 7. Ability to train, motivate, and teach individuals. 8. Ability to organize and coordinate multiple functions and tasks. 9. Willingness to evaluate current processes, offer suggestions for improvement, and adapt to change. WORKING CONDITIONS 1. Office environment. 2. Computerized environment, with data entry performed 40% of the time, and intense visual concentration on paper records and video display 50% of the time. 3. Searching and retrieval of records involved, including heavy lifting and carrying bundles of medical records.

Mount Auburn Hospital - 20 months ago - save job - block
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