DRG Validator

City/State: New York, New York Department: Clinical Documentation Improvement Work Shift: Day Work Days: MON-FRI Scheduled Hours: Day Scheduled Daily Hours: 8 HOURS Scheduled Weekly Hours: 0 Hourly Rate/Range: $50.00+ For positions that have only a rate listed, the displayed rate is the hiring rate but could be subject to change based on shift differential, experience, education or other relevant factors. A. Job Summary: The qualified candidate will be responsible for DRG assignment(s) for a wide variety of inpatient claims and multiple payers. The candidate will validate coded medical records to ensure that the correct severity of illness and intensity of service is captured and will assign codes involved in a variety of Quality data elements including: HAC, POA, Core Measures and other publicly reported data. Must be able to navigate various CMS-approved databases. B. Essential Job Qualifications 1. Education: High School Diploma/GED required. Associates Degree in a Health Information Management preferred. 2. Experience: At least 5 years progressive coding or coding review experience in ICD-10-CM with claims processing and data management responsibilities a plus. Experience with a CDI team preferred. Past auditing experience or strong training background in coding and reimbursement preferred. 3. Training/Certification: Formal HIM education with national certification (RHIA, RHIT) preferred. CCS coding certification required from the American Health Information Management Association. 4. Licensure: 5. Other: Good oral and written communication skills and comprehensive knowledge of the DRG structure and regulatory requirements C. Job Specific Contacts 1. General Contacts: Insurance companies, Peer Review Organizations, Medical Staff, Patient Financial Services, Secretary and Clerical Personnel, Ancillary Staff. Job Provides Direction to: Coders, Sr. Coders, ED Record Reimbursement Abstractor D. Environment and Demands 1. Environmental Demands: General Office 2. Essential Physical and Cognitive Demands, Manual Dexterity: General Office Part I: Hospital-Wide Standards A. Organizational Demonstrates adherence to Montefiore Nyack Hospital “We Care” standards including: WORKING TOGETHER “I will commit to work together in a courteous, respectful manner. I will demonstrate a positive spirit of service with all employees with whom I interact.” Place team success above individual recognition. Be receptive to new ideas and approaches within my workplace. Offer assistance generously without hesitation. EMPOWERMENT “I will be accountable, responsible, and self-directed in all aspects of my work at all times.” See projects through to ensure completion. Problem solve with patients, family members, and other employees. Follow up to ensure a resolution. COMMUNICATION “I will demonstrate positive communication in a clear, courteous and appropriate manner at all times.” Answer the phone within three rings if possible and identify myself, my department, and ask, “How may I help you”? Use effective verbal and written communication to patients, families, visitors, using the principles of AIDET (Acknowledge, Introduce, Duration, Explanation, Thank You) Use positive communication in my tone of voice, body language, and choice of words. Respond to e-mails in a courteous manner, with-in twenty-four hours. APPEARANCE “I will dress in a manner that reflects a professional and positive image of the hospital at all times” Maintain a clean, neat, and professional appearance which adheres to the hospital dress code policy. Promote and adhere to Montefiore Nyack Hospital's guidelines regarding a safe and clean work environment for employees, patients, families and visitors. RESPONSIVENESS “I will demonstrate the ability to provide timely feedback and communication to patients, visitors, and coworkers.” Respond to patient call lights and ask if I can assist. (No Pass Zone). Respond empathetically. Apologize for delays and concerns. EXCELLENCE IN SERVICE “I will strive to ‘do my best everyday’ in exceeding customer expectations.” Anticipate and address my patients’, families and visitors needs. Avoid negativity and exhibit a “can-do” attitude. “Manage up” fellow employees, physicians, departments, and the organization, to increase patient confidence both internally and in the community. Exit elevators to accommodate our patients’ first. Acknowledge people in the hallway by smiling and making eye contact. Help lost guests and new employees by escorting them to their destination. B. MISSION/STRATEGIC PLAN: Demonstrates support of the mission and strategic action plan through the initiation and ongoing implementation/evaluation of department activities/plans. C. JOB SPECIFIC COMPETENCIES: Demonstrates the technical/professional knowledge, skills and abilities necessary for the successful operations of the department including, where applicable, age specific competency. * Performing data and quality reviews on inpatient records to validate the ICD-10-CM codes, DRG group appropriateness, missed secondary diagnosis and procedures, and ensure compliance with all DRG mandates and reporting requirements. Monitors Medicare and other DRG paid bulletins and manuals and reviews the current OIG Work plans for DRG risk areas. Performing data and quality reviews on inpatient records to validate the ICD-10-CM, codes, DRG group appropriateness, missed secondary diagnosis and procedures, and ensuring compliance with all DRG mandates and reporting requirements. Continuously evaluating the quality of clinical documentation to recognize incomplete or inconsistent documentation for inpatient encounters that impact the code selection and resulting DRG. Providing/arranging for training of facility healthcare professionals in use of coding guidelines and practices, proper documentation techniques, medical terminology, and disease processes, appropriate to the job description and function as it relates to the DRG and other clinical data quality management factors. Query providers as needed. Collaboration with Clinical Documentation Specialists/Providers and HIM staff. Montefiore Nyack Hospital is an equal employment opportunity employer. Montefiore Nyack Hospital will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law.