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DRG Validation Auditor
Work Setting: Consultant/Vendor
Job Function: Auditor
Job Type: Full-Time
Salary Range: 85,000 to 95,000
Versalus Health is an innovative, rapidly growing organization that provides hospitals with comprehensive solutions focused on the intersection of utilization management, revenue cycle, and compliance. Versalus Health has expanded its product offering to include DRG Revenue Integrity services. By leveraging advanced analytics and DRG coding and clinical expertise, Versalus Health provides programmatic solutions for DRG coding compliance and revenue integrity. Versalus offers outstanding growth opportunities, a competitive salary and benefits package including bonuses based on individual and company performance, and reimbursement for continuing education and association dues. Versalus has a vibrant culture that strives to promote a positive work/life balance. Join our team and positively change healthcare!
The DRG Validation Auditor utilizes data analytics and proprietary algorithms to perform prebill or post bill DRG and Clinical Validation reviews to identify revenue integrity issues and opportunities. This position requires expert knowledge of MS-DRG and APR-DRG payment methodologies. The Auditor is responsible for validating ICD-10-CM/PCS codes by examining medical record documentation of clinical findings, care rendered, as well as the assignment of present on admission (POA) indicators and discharge disposition status for claims under review.
KEY RESPONSIBILITIES AND DUTIES:
- Identifies both over and under payments. Reviews medical records and other hospital documents to validate the clinical documentation to support the assigned ICD-10-CM/PCS code assignment, selection of the principal diagnosis and discharge disposition in accordance with CMS requirements, Official Guidelines for Coding and Reporting,and Coding Clinic
- Effectively Utilizes Audit Tools. Utilizes 3M encoder and grouper software with advanced proficiency. Enters audit findings into our proprietary application accurately and in accordance with standard procedures.
- Meets or Exceeds Standards for both Quality and Productivity set by the organization.
- Other responsibilities as assigned. Responsibilities may be subject to change at any time at the discretion of management, formally or informally, verbally or in writing.
Knowledge, Skills & Abilities
- Expert Coding and Clinical Validation Skills. Extensive regulatory coding (ICD-10-CM/PCS, MS-DRGs, APR-DRGs, Hospital Acquired Conditions (HACs), POA assignment, and Discharge Disposition codes) and associated reimbursement knowledge. Must demonstrate working knowledge of clinical indicators, risk factors and treatment protocols used for clinical validation and appropriate code assignments. Solid command of anatomy and physiology, diagnostic procedures, and surgical operations. Experience with multiple EHR systems such as Epic, Cerner and Meditech, etc.
- Critical Thinking. Actively and skillfully conceptualizes, applies, analyzes, synthesizes and evaluates information gathered from, or generated by, observation, experience, reflection, reasoning or communication as a guide to validate audit results and correct as necessary.
- Adaptability. Maintaining effectiveness when experiencing changes in work tasks or the work environment; adapts to change in environment and/or circumstances with a positive outlook and adjusts effectively to work within new work structures, processes, requirements, or cultures.
- Initiative. Independently takes prompt proactive steps towards problem resolution.
- Energy. Consistently maintains high levels of activity or productivity sustained over long working hours when necessary; operates with vigor, effectiveness, and determination.
- Stress Tolerance. Maintains stable performance under pressure or opposition.
- Planning and Organization. Proactively prioritizes initiatives, effectively manages resources with keen ability to multi-task. Able to prioritize key tasks and work in a complex environment.
- Communication Skills. Communicates clearly, proactively and concisely with all key stakeholders. Excellent written and verbal communication skills. Writes clear, compelling, accurate, and concise rationales in support of findings and successfully craft appeal letters with precise logic.
- Work Independently. Is self-supporting; not needing to rely on others to complete a job.
- Quality Orientation. Accomplishes tasks by considering all areas involved, no matter how small; shows concern for all aspects of the job; accurately checks processes and tasks; observant. Meets or exceeds both production & quality metrics assigned by the company, ensuring all rules and processes are followed.
- PC Skills. Demonstrates proficiency in Microsoft Office (Word & Excel) and ability to problem solve Internet connectivity issues, VPN access, etc.
- Committed to life-long learning.
- A minimum 5 years of hospital or vendor inpatient coding and/or CDI experience required.
- DRG appeal experience highly preferred.
May be expected to sit at a desk for long hours. Repetitive movement of hands and fingers – typing and/or writing. Occasional standing, walking, stooping, kneeling or crouching. Ability to reach with hands and arms, talk and hear.
Education & Certification:
- RN/RHIA/RHIT with CDIP or CCDS required. CCS highly preferred and will be required after one year of employment.
- CDI/coding certifications, and/or professional license must be maintained as a condition of employment.
Instructions for Resume Submission
Please email your resume to Christine Pagano at email@example.com
Apply Online: https://versalushealth.com/careers/
Posted: December 7, 2020 at 9:50 PM
Post ID: 56581