DRG Specialist at UPMC

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Full Time

Start Date

Immediate

Expiry Date

17 Dec, 25

Salary

0.0

Posted On

18 Sep, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Clinical Documentation, DRG Assignment, Coding Guidelines, Medical Record Review, Physician Queries, Training, Auditing, Communication, Critical Care, Prospective Payment System, Quality Assurance, Coding Education, Regulatory Compliance, Healthcare Regulations, Documentation Improvement, Resource Utilization

Industry

Hospitals and Health Care

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, principal diagnosis, secondary diagnoses, and PCS procedures have been coded accurately and completely in compliance with coding guidelines, third party payer and OIG regulations. Responsibilities: Focus emphasis of educational communications 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. 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. 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. Prepare and present training when requested on accurate DRG assignment for coding, CDI, and management personnel Assists with training of new DRG Specialists and coders as requested Provide coding staff with education, on a case level on any coding issues identified during reviews. Counsel/train coders on problems when necessary in coordination with the Coding Manager and assist in correcting deficiencies in DRG assignment. When requested, 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. 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. Attend and participate in meetings as requested. Three 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 Informations Administration program (RHIA) or Registered Health Information Technician (RHIT) or 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 (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 *Current licensure either in the state where the facility is located or, if the facility is in a state covered by the multistate Nursing Licensure Compact (NLC) agreement, a multistate license issued by a participating NLC state. Hires and current employees working on an out-of-state NLC license who later change their residency to the state where the facility is also located will have 60 days upon changing their residency to apply for licensure within that state. UPMC is an Equal Opportunity Employer/Disability/Veteran

Responsibilities

The DRG Specialist will review clinical documentation to ensure accurate coding of diagnoses and procedures in compliance with guidelines. They will also formulate physician queries and provide education to coding staff on identified issues.