Overview Under general supervision of the Coding Manager, the DRG Validator is responsible for review of medical records that have been coded within targeted DRG#s.# Reviews record for optimal DRG assignment; reports findings to Coding Manager and assists with development of proactive studies to assess coding quality in selected sub-populations.# Makes recommendations with regard to, and assists with, necessary in-service education. Responsibilities Reviews medical records of targeted DRG#s to analyze for optimal DRG assignment.# Interacts with Coders to discuss the findings and offer advice and education relative to improved coding optimization.
Performs quality assessment of departmental coding quality through statistically valid sampling techniques.# Develops reports of error thresholds, error rates and their causes. Identifies and documents positive and negative coding trends through daily interaction with coders and auditors. Designs and implements proactive studies to assess coding quality in selected sub-populations.# Researches and analyzes studies that have been prepared from regulatory and professional associations.
Formulates recommendations for education and in-service presentations to the coding staff. Acts as liaison with clinical departments, medical staff, medical records and others as determined. Conducts quarterly Ambulatory Surgery/Emergency Room reviews to ensure compliance with regulatory documentation guidelines.
Communicates directly with physicians to improve documentation. Works with ancillary staff, nursing, physicians, patient accounts, management and others as appropriate to validate billing and documentation practices. Coordinates the Blue Cross audits, establishes time frames and supplies all necessary information to the outside auditors.
Implements changes and updates with all parties involved.# Maintains database of all applicable changes and revisions. Meets departmental customer service and quality standards at all times by being courteous, helpful and professional. Requirements Two to three year#s prior coding experience utilizing ICD-10-CM and ICD-10-PCS and CPT coding methodology required.
Working knowledge of computers preferred. Level of knowledge generally acquired through two years of college or technical school in the HIM field. RHIT, RHIA, or CCS required.
An equivalent combination of education and experience which provides proficiency in the areas of responsibility listed above may be substituted for the above education and experience requirements. General office environment. Frequent use of computer terminal.
Frequent contact with physicians, nursing, administration, and finance and outside audit personnel. Must be able to perform all essential functions of this position with reasonable accommodation if disabled. The above statements are intended to describe the general nature and level of work being performed.# They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.# New England Medical Center reserves the right to modify position duties at any time, to reflect process improvements and business necessity.
Lowell General Hospital