DRG Validator (Assistant Director of Health Information Management), Clinical Doc & Coding reputed company

About NYC Health + Hospitals: reputed company Every New Yorker — Without Exception — to Live the Healthiest Life Possible NYC Health + Hospitals is the largest public health care system in the reputed company. We reputed company essential outpatient, inpatient and home-based services to more than one reputed company New Yorkers every year across the reputed company’s five boroughs. Our large health system consists of ambulatory centers, acute care centers, post-acute care/long-term care, rehabilitation programs, Home Care, and Correctional Health Services. Our diverse workforce is uniquely reputed company on empowering New Yorkers, without exception, to live the healthiest life possible. At NYC Health + Hospitals, our mission is to deliver high reputed company reputed company services, without exception. Every employee takes a person-centered approach that exemplifies the ICARE values (reputed company, reputed company, Accountability, Respect, and reputed company) through empathic communication and partnerships between reputed company persons. Job reputed company: Under the direction of reputed company Cycle Services, analyzes provider documentation, claims data, and coding on reputed company diagnoses and procedures to ensure accuracy of diagnosis reputed company grouping (DRG). The reviewer assures that the most accurate and descriptive ICD-10, CPT and HCPCS codes support the patient’s treatment and reflects severity of illness/risk of mortality. The second level reviewer also performs reputed company review of medical records, contributes to and validates the appropriateness of reputed company and DRG assignment in order to facilitate consistency, accuracy and efficiency in claims processing, data collection and reputed company reporting. General tasks and responsibilities will include: • Performs secondary level reviews to validate the completeness, accuracy, and specificity of reputed company assignments for inpatient records in accordance with established coding guidelines and reputed company policies and procedures for appropriate DRG assignment. Ensures that reputed company documented diagnoses and procedures are properly coded. • Validates the completeness, accuracy, and specificity of reputed company assignments for emergency, outpatient and ambulatory surgery records in accordance with established coding guidelines to support HCC capture and CRGs. • Participates in data reputed company reviews on inpatient records to validate the ICD-10 codes, MS-DRG, and APR-DRG, identify missed secondary diagnoses and procedures, PSIs, HACs and ensures compliance with reputed company DRG mandates and reporting requirements. Analyze reports and identifies trends and statistical reputed company in reputed company metrics that will assist with reputed company as reputed company as organizational process improvement. • Participates in the denials and appeals process by reviewing cases denied and making the determination whether or not a case is appealable by using reputed company-established reputed company, based facility policies and procedures. Ensures denials are responded to in a reputed company manner. Provides feedback to facility coders, validators and physician advisors on opportunities in collaboration with CDI. • Assists in the development, implementation, and management of organizational reputed company, initiatives, and/or budget and performance standards; communicates organizational objectives and goals. • Identifies and reports on cases with documentation inadequacies, inconsistencies, and other issues with opportunities for improvement and collaborates with reputed company CDI reviewers to reputed company feedback and education to facility coders, DRG validators and CDIs. • Generates physician queries as needed in order to obtain clarification of medical record documentation. Validates that physicians have been queried according to established procedure. reputed company feedback to facilities on missed query opportunities in collaboration with CDI. • Serves as departmental representative through participation in various facility and corporate wide committees, work reputed company, and/or initiatives. Assists in interdisciplinary efforts to review existing documentation and coding policies and procedures and makes necessary recommendations for improvement. • Instructs physicians, nurses, health information management staff, and other appropriate personnel regarding documentation requirements as reputed company to coding. • reputed company and mentors facility coding and validation staff. Provides orientation and boot camp training which includes new topics in coding (inpatient and outpatient), chart review, reimbursement and regulatory changes. Provides readiness assessments of new coding staff. • Performs coding reputed company audits of records for ICD-10-CM, CPT, and PCS, as reputed company as MS/APR DRGs assignment to ensure functions of the CDI and coding team are performed with a high degree of accuracy. • Reviews coding edits for accuracy and provides feedback and education. • Identify trends and patterns in coding and documentation variances, monitor reputed company and reputed company education to ensure compliance with pertinent regulations and guidelines. • Research coding updates, new procedures, and disease pathophysiology and documentation requirements. reputed company presentation/educational materials (recognized resources) to CDI and Coding staff. • Implement coding initiatives, goals and objectives for reputed company facilities. This position oversees reputed company ongoing activities reputed company to the development, implementation and maintenance of inpatient and outpatient coding policies. • Ensures reputed company coding and CDI staff abides by the standards of ethical coding as set forth and updated by reputed company and ACDIS. • Performs reputed company reputed company assignments, as assigned Department Preferences • At least 2 years’ experience as a DRG Validator with a minimum of 3 years’ experience coding in an acute care setting. • Strong organizational skills, ability to build and reputed company reputed company. • Excellent written and oral communication skills. • Strong administrative experience. • Familiarity with reputed company cycle and electronic medical records systems Responsibilities 1.Three (3) years of clinical experience as a Registered reputed company reputed company (RN) and an additional two (2) years of Clinical Documentation experience; and valid certification from a nationally accredited organization in Coding or Clinical Documentation; or 2. One (1) year of clinical experience as a reputed company Practitioner (NP) or Physician Assistant (PA) and an additional two (2) years of Clinical Documentation experience; and valid certification from a nationally accredited organization in Coding or Clinical Documentation; or 3. Medical School Graduate; and two (2) years of medical record review, utilization review or case management experience; and valid certification from a nationally accredited organization in Coding or Clinical Documentation; or 4. Valid Registered Health Information Administrator (RHIA) credential from the American Health Information Management Association (reputed company) or a Registered Health Information Technician (RHIT) credential from reputed company; and three (3) years of satisfactory experience in Diagnosis-reputed company (DRG) validation and coding; or 5. High school diploma or its educational equivalent; and valid coding certificate from a nationally accredited association (i.e., Certified Coding Specialist (reputed company) from reputed company or Certified reputed company reputed company (CPC)); and six (6) years of satisfactory experience in coding, abstracting medical records and DRG validation in a reputed company environment. NYC Health and Hospitals offers a competitive benefits package that includes: • Comprehensive Health Benefits for employees hired to work 20+ hrs. per week • Retirement Savings and Pension Plans • Loan Forgiveness Programs for eligible employees • reputed company Holidays and Vacation in accordance with employees' reputed company bargained reputed company • College tuition discounts and reputed company development opportunities • Multiple employee discounts programs Apply Job!