<p>The DRG Validator will be responsible for coordinating coding audits and education for Sturdy Memorial Hospital inpatient coding services. Quality reviews are performed to validate the ICD-10-CM and ICD-10-PCS codes, DRG appropriateness, missed secondary diagnoses and procedures, and ensure compliance and accuracy of the MS-DRG, APR DRG and other reimbursement(s) impacting elements. In addition, the DRG Validator will prepare, and present educational programs based upon audit findings. Other responsibilities include coding to support timely billing, writing appeal letters for DRG denials, and drafting coding guidelines to ensure coding consistency. The DRG Validator is responsible for exceeding quality and quantity expectations when performing coding and audit related functions.</p> <p>Education/Training:</p> <ul> <li>Associate's degree in Health Information Technology or Bachelor's degree in Health Information Administration </li></ul> <p>or</p> <ul> <li>Associate/Bachelors degree in another healthcare related field </li></ul> <p>or</p> <ul> <li>Related work experience in a similar role of five years (5) years may be substituted in lieu of education. </li></ul> <p>Licenses/Certification:</p> <ul> <li>Certified Coding Specialist (CCS) credential. </li></ul> <p>Required Qualifications and Skills:</p> <ul> <li>Minimum of 5 years of experience in complex coding in a hospital setting. </li><li>Knowledge as it relates to, but not limited to, electronic health record, health information systems and healthcare applications and their effects on Coding practices today and in the future. </li><li>Proficient in Microsoft Office Excel, Word and PowerPoint applications. </li><li>Knowledge and understanding of current ICD-10-CM and ICD-10-PCS Official Guidelines for Coding and Reporting. </li><li>High ethical standards. </li><li>Experience in ICD-10-CM/PCS, auditing, coding and reimbursement training. </li><li>Knowledge of Prospective Payment System (PPS) methodology for inpatient encounters. </li><li>Strong analytical abilities and problem-solving skills. </li><li>Excellent oral, written and interpersonal communication skills. </li><li>Ability to organize and set priorities to ensure objectives are met in a timely manner. </li><li>Ability to adapt to change and handle challenges proactively and with pose. </li><li>Ability to effectively collaborate with physicians and managerial staff at all levels. </li><li>Knowledge of laws and regulations about health information and patient confidentiality. </li></ul> <p>Essential Job Functions:</p> <ul> <li>Reviews high risk and high reward cases pre-bill to assure accurate sequencing, coding and abstraction. </li><li>Reviews discrepancies between Clinical Documentation Specialist's DRG and the Coder DRG for accuracy and opportunity. </li><li>Performs routine coding audits on 10% of each coder's work. </li><li>Prepares coding resource documents to support coding accuracy and consistency. </li><li>Performs Patient Safety Indicator and Hospital Acquired Condition reviews. </li><li>Ensures audit findings and trends are investigated and education is prepared and reviewed with coding staff when necessary. </li><li>Performs coding functions to maintain consistent turnaround times for coding to billing. </li><li>Prepares appeal letters to third part auditors when deemed appropriate. </li><li>Works with clinical and business associates to review and provide evidence-based determinations regarding the appealing, accepting and learning from denials. </li><li>Keeps abreast of new regulatory requirements, annual revisions to the codes, etc. and applies this information appropriately. </li><li>Works as subject matter expert and provides expertise when applicable. </li><li>Monitors changes in laws regulations, standards as they that affect coding, billing and related compliance. </li><li>Identifies potential areas of compliance vulnerability and risk, develops and identifies potential corrective action plans for resolution of problematic issues, and provides general guidance on how to avoid or deal with similar situations in the future. </li><li>Prepares and distributes audit results/reports for the system coding program to Coding management staff. </li><li>Attends meetings and educational conferences, assuming personal responsibility for professional development and ongoing education to maintain proficiency. </li><li>Other duties as assigned. </li></ul> <p>Other duties: Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.</p> <p>AGE AND DIVERSITY RELATED CRITERIA: Consistently treats patients, colleagues and visitors with the dignity and respect, while being sensitive to the differing needs of all age groups, backgrounds, characteristics and cultures.</p> <p>ABILITY TO FULFILL JOB EXPECTATIONS: Must have the ability to the perform essential functions of the position, including required work hours, locations and physical demands, without posing a direct threat to the health and safety of themselves or other individuals in the work place, and with or without reasonable accommodation.</p> <p>PHYSICAL DEMANDS:</p> <p>Prolonged periods of sitting at a desk and working on a computer.</p> <p>Must be able to lift up to 15 pounds at times.</p> <p>Sturdy Memorial Hospital is an equal employment opportunity employer. There is no discrimination because of race, color, creed, age, gender, sexual orientation, national origin, veteran status or disability.</p>