DRG VALIDATOR Job in Worcester, Massachusetts Us

5-7 years experience required
Experience with CPT/ICD-9 coding required

Summary: Under the general direction of the Coding Services Manager, the Coding DRG Validator performs quality reviews of records coded by the coding staff. Validates the ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification) codes and DRG (Diagnosis Related Group) assignments appropriateness to ensure consistency and efficiency in inpatient claims processing, data collection, and quality reporting for the Medical Center. Reports results, findings and recommendations to the Coding Services Manager, and assists with the development of process improvements to maintain data quality.

Qualifications: In-depth knowledge of coding/classification systems appropriate for inpatient, outpatient, and DRG prospective payment system. Ability to perform under significant levels of on-going pressure, ability to deal with physicians and others with tact, discretion and diplomacy. Ability to motivate, train and teach individuals demonstrated skills in interpersonal relationships and in oral and written communication. Ability to organize and coordinate multiple functions and tasks. Willingness to evaluate current processes, offer suggestions for improvement and adapt to change.

Required: Bachelor's Degree in Business or Health Care Administration; certification as a Registered Health Information Administrator (RHIA). Five years experience coding in a large, teaching, acute tertiary care setting with demonstrated coding expertise; certification as a Certified Coding Specialist (CCS) required. General knowledge of hospital information systems as well as an extensive knowledge of computer systems/applications used in Health Information. Knowledge of Joint Commission requirements and federal and state guidelines applicable to health record completeness and patient privacy

Preferred: Registered Health Information Technician (RHIT), preferred. Coding review experience in ICD9-CM with claims processing and data management responsibility preferred.

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