DRG Medical Coder Auditor

Accountability:

• Analyzes and audits acute inpatient claims. Integrates medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities. Draws on advanced ICD-10 coding expertise. Clinical guidelines, and industry knowledge to substantiate conclusions. Performs work independently.


• Adheres to official coding guidelines, coding clinic determinations, and CMS and other regulatory compliance guidelines and mandates. Requires expert coding knowledge –DRG &ICD 10.


• Establishes national and best practice benchmarks and measures performance against benchmarks.


• Ensures accurate payment by independently utilizing DRG grouper, encoder, and claims processing platform.


• Manages case volumes and review/audit schedules, prioritizing case load as assigned by EHP Management.


• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.

Qualifications:

• Degree in health information management (RHIA or RHIT) or a Nursing Degree.


• Three (3) years’ experience in claims auditing, quality assurance, or recovery auditing, of (MS/APR) DRG coding for hospital or other acute facility setting.


• Three (3) years of working experience with ICD 10CM, MS-DRG, and APR-DRG with a broad knowledge of medical claims billing/payment systems, provider billing guidelines, medical necessity criteria, and coding terminology


• Coding Certification is to be maintained as a condition of employment of one of the following: RHIA or RHIT, Inpatient Coding Credential – CCS or CIC.


• Intermediate analytical and problem-solving skills; as well as keeps abreast of latest trends related to business analysis.