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

Provide clinical leadership in an inter disciplinary team in a professional, knowledgeable, and efficient manner to drive client results, exceed client expectations, and foster client confidence Maintain a functional and collaborative relationship with the DRG Integrity Specialist to achieve shared company goals Comply with medical and federal guidelines at all times Reso

The Inpatient Coder II is the second level coding position in a 3 tier career ladder. Inpatient Coder IIs will evaluate inpatient medical records and accurately assign the appropriate ICD 10 CM/PCS codes, Present on Admission (POA) indicators, and relevant DRGs. The Coder II must be skillful in the identification and assignment of all diagnoses and procedures in accordanc

Act as a liaison for internal monitoring, reporting, and communicating Accuity turn around times that directly impact client final billing, including processing data and sharing with the RCA team Reviewing DNFB reports and deciphering activities that may have taken place within the DNFB report, providing analytical feedback Working efficiently and in a timely manager to s

Performs data reconciliation and validation processes Ensures client data integrity in key internal systems as well as maintaining the process to support the data management and reporting team Analyze and resolve data integrity issues and manage revisions as needed to best meet internal and customer requirements Manipulates and analyzes client data from internal system so

Adhere to and maintain required levels of productivity and quality performance KPIs Maintain up to date coding knowledge by reviewing materials disseminated/recommended by the Physician Staff, Coding and CDI Leadership Participate in Coding department meetings and educational events as assigned Maintain a collegial working relationship with CDI and Coding and Client Succe

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