The clinical Reimbursement Manager/DRG Validator is responsible for performing quality reviews on medical records to validate the ICD-9-CM/ICD-10-CM codes, DRG appropriateness, missed secondary diagnoses and procedures, and ensure compliance and accuracy of the MS-DRG and APR DRG. The clinical Reimbursement Manager/DRG Validator will continuously evaluate the quality of clinical documentation and monitor the appropriateness of physician queries with the overall goal of improving physician documentation through physician education and feedback and achieve accurate coding to support the optimal allowable reimbursement. The Clinical Reimbursement Manager/DRG Validator works closely with the Coding Manager to provide coding coding staff with feedback to assure coding uniformity, consistency and accuracy with ICD-9-CM/ICD-10-CM and CPT-4 guidelines, UHDDS, sequencing guidelines, Federal and State regulations and the American Hospital Association coding guidelines and its publications Coding Clinic and AMA's publication CPT Assistant. The Clinical Reimbursement Manager/DRG Validator works in conjunction with the Director of Health Information Management to develop coding in-services and institutional coding policies to ensure that coding policies complement the official rules and guidelines.
1. RHIT, RHIA or equivalent degree or related experience
2. 3-5 years of related experience, working in acute care hospital
3. Certified Coding Specialist Certification (CCS) - (with ability to meet coding quality and quantity expectations, DRG validation, & auditing experience).
4. Strong foundation in clinical medicine, ICD-9 CM/ICD-10-CM and CPT-4 Coding
5. Knowledge of medical terminology
6. Must be detail oriented with good verbal, written, communication, interpersonal and customer friendly skills
7. Microsoft Office Skills (MS Word, Excel, Power Point)
Mount Sinai Medical Center is an equal opportunity/affirmative action employer. We recognize the power and importance of a diverse employee population and strongly encourage applicants with various experiences and backgrounds.
Mount Sinai Medical Center--An EEO/AA-D/V Employer.
Mount Sinai Medical Center