[Hiring] DRG Specialist @UPMC

Role Description

UPMC Corporate Revenue Cycle is hiring a DRG Specialist to work on inpatient auditing within our Coding Department. This position will be a work-from-home position working during standard business hours Monday through Friday.

In this role, you will review clinical documentation within the medical record to ensure that all patient resource utilization, diagnostic complications and co-morbidities have been coded in compliance with coding guidelines, third-party payer and OIG regulations.

• Review and evaluate focused UPMC DRG medical records for accurate DRG assignment.
• Ensure that all documented principal and secondary diagnoses, including all complications and co-morbidities, and procedures are accurately coded and sequenced according to coding and compliance guidelines.
• Meet with coding management as scheduled to review progress, discuss problems, and initiate new programs or activities.
• Function as a resource person to respond to special audits and projects assigned by Management or requested by other departments.
• Perform audits as requested by internal departments and outside payers/agencies.
• Investigate, correct (if necessary), and respond to requests for record review relative to discharge disposition, admit or discharge date, invalid codes, etc.
• Facilitate compliance to the Medicare 72-Hour Rule by identifying and investigating related admissions.
• Coordinate DRG reimbursement issues among coding, nursing administration, Patient Business Services, medical staff, case management, and other ancillary departments.
• Track and report quality statistics of the coding personnel from focus chart audits.
• Provide coding staff with updates on any coding issues and educational information as necessary.
• Counsel/train coders on problems when necessary in coordination with the Coding Manager and/or Coding Specialist.
• Prepare monthly productivity reports of DRG revenue profiles to identify total amount of optimization and missed opportunities.
• Attend and participate in Committee meetings as requested.
• Investigate and respond to payment and/or DRG Assignment denials by Workers Compensation and other insurers.
• Identify and report issues and trends to the coding management.
• Focus emphasis of educational presentations on accurate and thorough documentation necessary to support the coding of diagnoses and procedures.
• Review billing data when conducting focused chart audits to ensure it is complete and accurate.
• Prepare and present in-service training on accurate DRG assignment for coding personnel, medical staff, physician extenders, nursing case management, and ancillary departments.
• Assist the Coding Manager with auditing coders' work as requested.
• Formulate physician queries that present indications of a diagnosis that is not clearly documented in the medical record.

Qualifications

• 3 years of previous clinical acute care medical/surgical experience to include critical care in conjunction with an expanded knowledge of DRG's; OR completion of Registered Health Information Administration program (RHIA) or Registered Health Information Technician (RHIT) or CCS AND 3 years of experience with the Prospective Payment System and DRG selection; OR specific knowledge as a consultant in Medical Record coding and DRG assignment required.
• 3 years of inpatient coding experience is preferred.
• Knowledge of computer technology, quality assurance activities, DRG methodology background is highly preferred.
• Ability to communicate with staff, physicians, healthcare providers, and other health care system personnel in a professional and diplomatic manner required.

Requirements

• Licensure, Certifications, and Clearances:
• Certified Coding Specialist (CCS) OR Certified Professional Coder (CPC) OR Certified Registered Nurse Practitioner OR Doctor of Medicine (MD) OR Registered Health Information Administrator OR Registered Health Information Technician (RHIT) OR Registered Nurse (RN)
• Act 34

Company Description

UPMC is an Equal Opportunity Employer/Disability/Veteran.