Staff Title: DRG/APG Reviewer
Reports to: Senior Director of Coding
Working Conditions: Full time (M-F) Office and Community Business Settings and Remote positions considered.
Position Summary: DRG/APG Validators review charts on behalf of our clients to assist in cost containment. Our approach to chart review encompasses coding guidelines and clinical evaluation with a goal towards eliminating unjustified over payment.
- Visual and Auditory comprehension & function for written & verbal communication.
- Manual Dexterity with ability to use computers and other office equipment necessary to perform assigned tasks
- Ability to access various settings, negotiate architectural barriers (i.e. stairs) in office and community settings
- Ability use public transportation to commute to work
- Ability to prioritize and organize workload and complete tasks independently
- Ability to communicate effectively both orally and in writing
- Knowledge of various computer software programs and able to demonstrate computer skills
- Individual must have a minimum of three years’ experience in DRG Validation/Claims/Inpatient coding
- Required Certifications ICD-10-CM/CPT coding, Registered Heath Information Technician (RHIT), Registered Health Information Administrator (RHIA) or Certified Coding Specialist (CCS), or RN with above Coding Certifications a plus
- Able to work closely with physicians
- Ability to justify decisions both in writing and verbally
- Validate ICD-10-CM coding to ensure proper DRG assignment in order to screen out over billed cases
- Validate/assign CPT codes to assure proper billing
- Refer cases with possible utilization and/or quality issues
- Bring to the attention of the managers and other key staff involved in the review process of any other issues and problems that case review may present
- Perform on-site reviews within and outside of New York State as assigned
- Perform varied types of reviews in central office when assigned
- Adhere to and maintain qualitative and quantitative standards.
- Coordinate and collaborate on scheduled on-site reviews with other reviewers and the host department in order to ensure the timely completion of the review
- Record review decisions and justifications for changes requested or issues raised
- Report daily and weekly output.
- Inform the personnel involved in the review process of any applicable coding guidelines, conventions and information that will ensure quality in DRG reviews.
- Maintain professional credentialed status by participating in approved continuing education programs and seminars
- Perform other duties related to the review process as deemed necessary by the Director.
Should you have interest in the above position, please email or fax your resume to:
Human Resources Department
Fax to: 212-897-6050
E-mail to: firstname.lastname@example.org (you may click on this link to send)
(Please attach resume in MS Word or WordPerfect format)
For information on how to apply for this position, click here.