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DRG Auditor

Description:

Responsibility:

The DRG Analyst has an extensive coding and reimbursement background and is responsible for auditing inpatient medical records and assigning ICD-10 diagnosis and procedure codes in accordance with the ICD-10 Official Coding Guidelines and AHA Coding Clinic Guidelines.

The DRG Analyst also screens claims data and responds to provider appeals, rebuttals, and disputes.

The DRG Analyst works closely with Clinical Validation Auditors to refer audits for clinical review.

·        Primary Duties/Responsibility 1: Performs DRG Audits by applying extensive knowledge of coding guidelines while maintaining productivity targets.

o  25%

·        Primary Duties/Responsibility 2: Demonstrates ability to appropriately apply coding guidelines to a variety of claims scenarios and effectively utilize audit tools to maximize savings.

o  25%

·        Primary Duties/Responsibility 3: Performs appeal reviews and responds to provider disputes for coding audits.

o  25%

·        Primary Duties/Responsibility 4: Screens claims data including MS-DRG and APR-DRG data.

o  25%

• Communicates audit findings with excellent grammar and writing skills.

• Responds to providers with audit results

• Demonstrates ability to research criteria and evaluate it for accuracy.

•  Ability to perform in-depth analysis of medical record documentation relating to diagnoses and procedures

• Maintains current knowledge of coding guidelines, reimbursement trends, and client expectations.



Requirements:

  • Minimum of 3 years of experience as an acute inpatient coder or related coding experience
  • Competency in ICD-10 CM & PCS
  • Registered Health Information Technologist (RHIT), Registered Health
  • Information Administrator (RHIA), or Certified Coding Specialist (CCS)
  • Works independently to meet or exceed productivity and accuracy goals.
  • Demonstrates commitment to Change Healthcare core values.
  • Ability to use software, hardware, and peripherals related to job responsibilities, including MS Office
  • Excellent verbal and written communication skills
  • Excellent analytical, organizational, and prioritization skills
  • Ability to learn quickly and multi-task in a fast-paced environment

 

The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

Salary: ₱50000 - ₱70000
Address: BGC, Taguig