DRG Validation Auditor [For Pooling]

Position Description:

The DRG Validation Auditor is responsible for reviewing medical records to determine the accuracy of coding and reimbursement for clinical services rendered to beneficiaries of health plans, including Commercial and Government Clients.

Your future duties and responsibilities:

 Reviews inpatient medical records to validate, assignment and sequencing of ICD-9-CM and ICD-10 diagnosis and procedure codes, discharge status codes, and DRG assignment.
 Provides a detailed rationale for every medical record review resulting in a DRG Review Results letter, including supporting references.
 Follows proper procedure for referral to Clinical Nurse Auditor or Physician Advisor, as applicable.
 Utilizes proper reference material, standards, and guidelines for coding.
 Provides input to the Edit Development team on claims selection criteria.
 Verifies data received from client and work to resolve discrepancies.
 If the contract requires onsite review, interacts with Providers and other personnel in a professional manner.
 Follows CGI Federal policies and processes, completing Red Carpet, timesheets, payroll, travel expense documents, and other corporate requirements in a timely manner.
 Communicates timely with Team Lead regarding illnesses, appointments, vacation requests, changes in work schedule, performance barriers, and computer issues.
 Complies with department standards regarding productivity and audit quality.
 Performs other duties as assigned.

Required qualifications to be successful in this role:

 Possesses current AHIMA credentials (RHIT/RHIA/CCS), with current CCS preferred
 Demonstrates extensive knowledge of ICD-9-CM and ICD-10 coding and DRG reimbursement, with a minimum of five years of inpatient coding experience
 Previous experience training and mentoring junior-level coders is highly desired
 Must understand government and commercial provider reimbursement methodologies, and possesses strong data analytic skills
 Ability to write a well-reasoned review in a narrative style, with accurate spelling, grammar, punctuation, and sentence structure is required
 Must be able to adapt to changing priorities in order to meet Client requirements, and is required to meet department productivity standards and deadlines
 Amenable to work in shifting schedule
 Temporary WFH (Office Location: Mckinley, Taguig/Alpha, Pasig)