As a valued member of the DRG Review Team, the DRG Integrity Specialist performs a secondary level review of medical records and code assignment using knowledge of Accuity technology and client systems with a physician in accordance with federal coding regulations and guidelines as well as client specific coding guidelines to ensure accurate DRG assignment. This function

Performs review of the medical record including documentation, reports, flowsheets, and test results, applying evidence based criteria related to DRG and clinical validation denials Creates appeal letters utilizing the relevant information from the medical record; supported by current clinical standards and facility guidelines, evidence based medicine, professionally reco

Monthly monitoring of the clinical dashboard demonstrating improvement in statistical targets. Communicates with Leadership across the regions to develop educational programs that address the identified opportunities to improve clinical dashboard results Identifies strategic plans that will positively impact the clinical dashboard Through relationship development across t

Assigns appropriately sequenced and compliant ICD 10 CM/PCS codes as documented in the electronic medical record (EMR). Applies definition of principal diagnosis for proper assignment of MS DRGs, APR DRGs, and POA indicators using a designated encoder/grouper, while ensuring compliance with nationally established coding guidelines. Utilizes selected encoder and/or compute

The UR Coordinator is responsible for collaborating with healthcare providers, clinical staff, and patient's to promote quality care outcomes, and the effective use of resources. Additional duties include accurately interpreting treatment plans and medical records in accordance with current standards of care along with accurately interpreting participating Managed Care Or

As a valued member of the DRG Review Team, the DRG Integrity Specialist performs a secondary level review of medical records and code assignment using knowledge of Accuity technology and client systems with a physician in accordance with federal coding regulations and guidelines as well as client specific coding guidelines to ensure accurate DRG assignment. This function

Utilizes technical coding expertise to assign appropriate ICD 10 CM and ICD 10 PCS codes to complex inpatient visit types. Complexity is measured by a Case Mix Index (CMI) and Coder II's typically see average CMI's of 2.2609. This index score demonstrates higher patient complexity and acuity. Utilizes expertise in clinical disease process and documentation, to assign Pres

Utilizes technical coding expertise to assign appropriate ICD 10 CM and ICD 10 PCS codes to complex inpatient visit types. Complexity is measured by a Case Mix Index (CMI) and Coder II's typically see average CMI's of 2.2609. This index score demonstrates higher patient complexity and acuity. Utilizes expertise in clinical disease process and documentation, to assign Pres

Utilizes technical coding expertise to assign appropriate ICD 10 CM and ICD 10 PCS codes to acute rehab cases and inpatient OB and Newborn discharges. Complexity is measured by a Case Mix Index (CMI) and IP Coder Associate's typically see average CMI's of 0.5759 with the OB and Newborn population. This index score demonstrates lower patient complexity and acuity. Utilizes

Review pre bill cases simultaneously with a physician during each work shift excluding breaks and meetings to analyze and validate diagnosis and procedure codes for inpatient services via coding compliance and clinical knowledge to support accurate DRG assignment Utilizes Accuity technology for tracking of coding errors, query opportunities and other data collection as ne

Utilizes technical coding expertise to assign appropriate ICD 10 CM and ICD 10 PCS codes to complex inpatient visit types. Complexity is measured by a Case Mix Index (CMI) and Coder II's typically see average CMI's of 2.2609. This index score demonstrates higher patient complexity and acuity. Utilizes expertise in clinical disease process and documentation, to assign Pres

Utilizes technical coding expertise to assign appropriate ICD 10 CM and ICD 10 PCS codes to inpatient acute care visit types up to 6 days length of stay across all Medical and Surgical service lines.. Complexity is measured by a Case Mix Index (CMI) and Coder I's typically see average CMI's of 1.4 with this mix of the acute care population. This index score demonstrates m

Develops curriculum and materials for documentation training programs. Assesses coder comprehension. Conducts quality assurance reviews. Reviews, researches, and responds to coding questions. Resolves coding questions from patient inquiries or denied services from insurance companies. Performs focused quality assurance reviews on coded services. Communicates updates on co

Utilizes technical coding expertise to reviews the medical record thoroughly, utilizing all available documentation abstract and code physician professional services and diagnosis codes (including anesthesia encounters, operative room and surgical procedural services, invasive procedures and/or drug infusion encounters). Additionally, may include coding for Evaluation and

Assess the clinical indicators and suggestions of various query requests received from the MD Reviewer/ DRG Integrity Specialist Collaborate and communicate as necessary to clarify and avoid misinterpretation to ensure the query is optimally written and distributed to the correct client provider Creates queries in a compliant manner in accordance with AHIMA and ACDIS comp