Case Mix Manager/Data Manager
Saint Agnes Hospital - Baltimore, MD

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High School Diploma/GED
  • CCS, RHIT or RHIA
  • Minimum of 3 years of experience
  • Summary: Validates APR-DRG assignments and severity level for accuracy of coding and complete documentation. Serves as liaison with Medical Record Technicians and Care Managers to ensure appropriate use of on-line queries for clarification of physician diagnosis/procedure documentation. Interacts with physicians to clarify documentation and/or responses to queries to ensure accurate coding for APR-DRG assignment. Audits outpatient records for accuracy of ICD-9-CM and CPT Codes and outpatient grouping system.

    Principle Duties and Responsibilities:
    • Reviews inpatient medical record documentation to validate APR-DRG’s assigned and severity of illness level.
    • Reviews outpatient medical records for accurate Icd-9-CM and CPT codes and accurate groupings.
    • Provides education for inpatient and outpatient coders.
    • Ensures accurate DRG assignments for Medicaid patients on 3808’s.
    • Audits abstracts for accurate data selection.
    • Serves as liaison with Medical Record Technicians and Care Managers to ensure appropriate use of on-line queries for clarification of physician diagnosis/procedure documentation.
    • Interacts with physicians to clarify documentation for Outpatient records and/or responses to queries to ensure accurate coding for APR-DRG assignment.
    • Participates in department and section meetings as required.
    • Attends education conferences in order to maintain required credentials.
    • Maintains knowledge of all new regulations and coding changes.
    • Sequences ICD-9-CM diagnosis and procedure codes to ensure accurate APR-DRG assignment and accurate severity level.
    • Analyzes case mix data for selection of records to be audited.
    • Maintain the privacy and confidentiality of protected health information.
    • Complies with the standards of conduct and CRP
    • Performs other duties as assigned.
    Required Education: High School Diploma or equivalent

    Required Certifications, Licenses, Registrations: Certified Coding Specialist ( CCS) or Registered Health Information Technicians ( RHIT) or Registered Health Information Administrators ( RHIA)

    Required Experience: Three (3) years’ experience in an acute care inpatient/outpatient s urgery coding experience serving in a data management, coding management or coding auditing position. ICF-9-CM and CPT coding experience.
    Saint Agnes Hospital - 19 months ago - save job - block
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