Job Description

Job Title: Diagnosis Related Group (DRG) Specialist
Job ID: 729991
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility:
Department: Rev Cyc Coding
Location: 2 Hot Metal Street, Pittsburgh PA 15203

Description

Purpose:
The Revenue Cycle team is searching for a DRG Specialist to join them!  This role 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.

This role is Monday through Friday during daylight hours.  It is based at the Quantum building in Pittsburgh, but can work remotely after training is complete.  

Responsibilities:
  • Assist the Coding Manager with auditing coders' work as requested.
  • Attend and participate in Committee meetings as requested. Investigate and respond to payment and/or DRG Assignment denials by Workers Compensation, and other insurers.
  • Coordinate DRG reimbursement issues among coding, nursing administration, Patient Business Services, medical staff, case management, and other ancillary departments directly affected by DRG assignment.
  • Counsel/train coders on problems when necessary in coordination with the Coding Manager and/or Coding Specialist and assist in correcting deficiencies in DRG assignment.
  • Facilitate compliance to the Medicare 72-Hour Rule by identifying and investigating related admissions, making the appropriate adjustments to the coding system, contacting the Admitting department for registration issues, and reporting outcomes to the Patient Business Services department for appropriate reimbursement.
  • Focus emphasis of educational presentations on accurate and thorough documentation necessary to support the coding of diagnoses that were treated, monitored and evaluated and procedures that were performed during an episode of care.
  • Formulate physician queries that present indications, utilizing clinical judgment, of a diagnosis that is not clearly documented in the medical record and request appropriate documentation to support the additional diagnosis.
  • Identify and report issues and trends to the coding management.
  • Investigate, correct (if necessary), and respond to requests for record review relative to discharge disposition, admit or discharge date, invalid codes, etc. from requesting departments to ensure timely, accurate reimbursement. Investigate and address research accounts requiring V70.7 code assignment. Review focused charts at a rate in accordance with departmental standards.
  • Meet with coding management as scheduled to review progress, discuss problems, and initiate new programs or activities relative to the information obtained from these reports. 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
  • Prepare and present in-service training on accurate DRG assignment for coding personnel, the medical staff, physician extenders (PAs, CRNPs), nursing case management and ancillary departments.
  • Prepare monthly productivity reports of DRG revenue profiles to identify total amount of optimization and missed opportunities.
  • Provide coding staff with updates on any coding issues and educational information as necessary.
  • Review and evaluate focused UPMC DRG medical records for accurate DRG assignment to 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.
  • Review billing data when conducting focused chart audits to ensure it is complete and accurate.
  • Track and report quality statistics of the coding personnel from focus chart audits and report this information to the Coding Manager on a monthly basis.

Qualifications

  • Three years of previous clinical acute care medical/surgical experience to include critical care in conjunction with an expanded knowledge of DRGs 
    • OR completion of Registered Health Information Administration program (RHIA) or Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS) AND three 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. 
  • 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.

Licensure, Certifications, and Clearances:
  • Certified Coding Specialist or Certified Registered Nurse Practitioner or Medical Doctor or Registered Health Information Administrator or Registered Health Information Technician or Registered Nurse

UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $22.60 to $39.11

Union Position: No

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