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Clinical Reimbursement Manager
Mount Sinai

Location: New York, Remote
Work Setting: Hospital
Job Function:
Coding – Auditor
Job Type:
Full-Time
Salary Range: 100K+

Introduction

The Mount Sinai Health System believes that diversity and inclusion is a driver for excellence. We share a common devotion to delivering exceptional patient care. Yet we’re as diverse as the city we call home- culturally, ethically, in outlook and lifestyle. When you join us, you become a part of Mount Sinai’s unrivaled record of achievement, education and advancement as we revolutionize healthcare delivery together.

We work hard to recruit and retain the best people, and to create a welcoming, nurturing work environment where you have the opportunity and support to develop professionally. We share the belief that all employees, regardless of job title or expertise, have an impact on quality patient care.

Explore more about this opportunity and how you can help us write a new chapter in our story!

The Mount Sinai Health System believes that diversity and inclusion is a driver for excellence. We share a common devotion to delivering exceptional patient care. Yet we’re as diverse as the city we call home- culturally, ethically, in outlook and lifestyle. When you join us, you become a part of Mount Sinai’s unrivaled record of achievement, education and advancement as we revolutionize healthcare delivery together.

We work hard to recruit and retain the best people, and to create a welcoming, nurturing work environment where you have the opportunity and support to develop professionally. We share the belief that all employees, regardless of job title or expertise, have an impact on quality patient care.

Explore more about this opportunity and how you can help us write a new chapter in our story!

Job Description

Duties and Responsibilities:
1. Performs SMART focused reviews on ICD-10-CM/PCS coded inpt medical records to validate accuracy of codes assigned, selection of principal diagnosis/principal procedure, & to identify missed addt’l diagnoses/procedures in accordance w/ coding guidelines.
2. Validates the accuracy and appropriateness of the DRG assignments flagged pre-billing.
3. Determines if a secondary review is required to verify assignment of Patient Safety Indicators, HAC, Clinical Documentation Improvement,Sepsis and any other charts meeting criteria for secondary review.
4. Initiates an MD query to clarify documentation in the medical record for documentation, integrity and accurate code assignment essential to support documentation of medical diagnoses or conditions that are clinically evident.
5. Reviews coder queries to determine if the query is supported and generates query to provider.
6. Reviews cases with coding and/or DRG changes proposed by insurers, vendors, PFS to reconcile coding and/or DRG discrepancies.
7. Provides feedback to coders on all coding changes thru SMART by documenting detailed rationale for change in both SMART and 3MHDM.
8. Updates Artifact, 3M-360 and HDM with all query responses and selects the correct response to designate impact.
9. Investigates reason for unbilled accounts or PFS edits due to diagnoses, procedures or DRGs, acts to combine stays, clears SPARCs edits, & provide missing dates of procedures or dialysis treatment. Resolves edits and rebills cases in 3M.
10. Reviews and reconciles DRG discrepancies between DRGS/APR’s and the Clinical Documentation Quality Improvement (CDQI) department. Develops and maintains a close working relationship with CDQI staff.
11. Consistently meets established productivity and quality targets for work assignments.
12. Responds timely to email notifications and team messages from DRGV management.
13. Communicates, cooperates and maintains open communication with DRG management, CDI, Coders, and departmental staff.
14. Adheres and enforces all requirements related to HIPAA and confidentiality, privacy and security of patient records.

Required Qualifications

Education:
• Associate (AS) degree in Health Information Management, or equivalent degree in related health field is preferred
• Clinical coding Specialist Certification (CCS, CCS-P) required.
Minimum of 3 to 5 years of experience coding in an acute care hospital. Validation and auditing experience preferred.
• Excellent current knowledge of MS-DRGs, APR-DRGs reimbursement methodology

Education Qualifications

Education:
• Associate (AS) degree in Health Information Management, or equivalent degree in related health field is preferred
• Clinical coding Specialist Certification (CCS, CCS-P) required.
Experience:
• A strong background in anatomy, physiology, pharmacology and working experience with ICD-10-CM and ICD-10-PCS coding is required.
• Minimum of 3 to 5 years of experience coding in an acute care hospital. Validation and auditing experience preferred.
• Excellent current knowledge of MS-DRGs, APR-DRGs reimbursement methodology.
• Good working knowledge of electronic health records, registration and data systems.

Instructions for Resume Submission

REG ID# 2743340 Clinical Reimbursement Manager; HSO DRG Validation

Apply Online: https://careers.mountsinai.org/jobs

Posted: March 9, 2022 at 8:30 AM
Post ID: 67301

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