DRG Coding Specialist

3 weeks ago


New York, New York, United States TAL Healthcare Full time

Job Summary:

TAL Healthcare is seeking a skilled DRG Coding Specialist to join our team. As an Inpatient DRG Validator, you will be responsible for ensuring the accuracy of coding and provider documentation in compliance with Uniform Hospital Discharge Data Set (UHDDS) and Medicare guidelines.

Key Responsibilities:

  • Perform concurrent and retrospective clinically based and MS-DRG and APR DRG validation reviews.
  • Review the correct assignment of ICD-10-CM diagnosis & ICD-10-PCS procedure codes.
  • Effectively utilize facility Encoders, EMRs, abstracting systems, and auditing tools proficiently to make audit determinations.
  • Write clear, accurate, and concise rationales supporting audit findings.
  • Compose physician queries for clarification of documentation.
  • Provide coder education referencing applicable coding references following audits.
  • Review DRG/coding denial letters and compose effectively supported appeal response letters to third-party auditors and insurance carriers.
  • Provide written recommendations for optimal coding and DRG / SOI assignment.
  • Maintain proficiency on the Official Coding Guidelines for Coding and Reporting and AHA Coding Clinics.

Requirements:

  • Must have one of the following AHIMA certifications: CCS, RHIT, or RHIA
  • Extensive knowledge of medical terminology, anatomy, coding terminology, and coding guidelines for ICD-10-CM/PCS, CPT, Modifiers, etc.
  • Equivalent experience of 5+ years in DRG/Clinical Validation claims auditing, quality assurance, or recovery auditing.
  • Minimum of 5+ years of working with ICD-10-CM/PCS, MS-DRG, and APR-DRG with a broad knowledge of medical claims billing/payment systems and payer reimbursement policies.

Salary: $80,000 - $110,000 per annum, depending on experience and qualifications.


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