Supervisor, DRG Reviews and Validation

3 weeks ago


Phoenix, Arizona, United States Triwest Healthcare Full time
Job Summary

We are seeking a highly skilled and experienced Supervisor to lead our DRG Coding and Validation team. The successful candidate will be responsible for supervising the DRG validation process and coding staff to ensure contractual compliance.

Key Responsibilities
  • Supervise retrospective coding validation reviews of medical claims and associated reporting processes.
  • Supervise staff processes for requesting, obtaining, filing, and managing medical records.
  • Utilize management reports to support DRG validation and medical record processes.
  • Coordinate coding matrix validation, program sets, profile structure and maintenance, and routine updates for coding and policy changes due to profiles.
  • Assist staff with the application of complex coding conventions to appropriately code and sequence medical claims for claims payment and DRG validation purposes.
  • Stay current with updated coding information and changes in coding regulations and practices.
  • Serve as Subject Matter Expert for coding issues, including implementation of new codes.
  • Develop materials and train assigned staff on coding guidelines, compliance issues, and coding policy changes, medical record process changes as appropriate.
  • Coach/mentor staff on performance standards, employee issues and concerns.
  • Interpret relevant sections of the TRICARE Operations Manual, TRICARE Policy Manual, and TRICARE Reimbursement Manual to perform functions.
  • Perform focused audits to ensure compliance with coding requirements and medical record maintenance and confidentiality.
  • Interact with internal and external entities on resolving customer services issues to ensure customer service needs are met.
Requirements
  • Bachelor's degree or equivalent combination of education and experience.
  • Current Certification as Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), or Certified Professional Coder (CPC).
  • 2+ years of clinical experience.
  • 2+ years coding experience.
  • 2+ years processing medical claims.
  • 2+ years of UM experience utilizing commercially developed UM criteria.
  • 2+ years supervisory/management experience.
Preferred Qualifications
  • Managed Care experience.
  • Familiarity with TRICARE and military health care delivery system.
Working Conditions
  • Availability to work any shift.
  • Works remotely, with up to 10% travel.
  • Ability to meet mandatory contract compliance timelines.
  • Extensive computer work with prolonged sitting.


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