Remote DRG Validator & Coding Quality Reviewer
Job Description & Requirements
Remote DRG Validator & Coding Quality Reviewer
StartDate: 12/9/2024
Pay Rate: $40.00 - $60.00
DRG Validator and Coding Quality Reviewer
Responsibilities:
To perform inpatient coding and DRG validation & other reviews by verifying coding accuracy & compliance.
The Contractor must perform pre-billing data quality reviews of Client employees and other (vendor) coders’ inpatient coding as part of the department’s coding compliance program. The types of accounts and topics to be reviewed are dependent on the needs of CLIENT coding management.
CLIENT reserves the right to expand the list of DRGs, diagnosis and/or procedure codes to be reviewed on a pre-billing basis based on changing compliance requirements.
The types of reviews include but are not limited to:
• Pre-billing data quality/DRG reviews of inpatient and same day surgery/medical cases including DRG transfer reviews
• Pre-billing review of all mortality and potential PSI/HAC accounts
• Pre-review of physician queries as requested
• External coding review responses (i.e., to Blue Cross, OmniClaim, RAC, etc.)
• Pre-billing review of new coder’s work as requested
• Pre-billing review of POA indicators
• Coding/claim error questions from Patient Accounts
• Coding questions from core measures abstractors
• Collaboration with CDI related to documentation queries. The Contractor must complete pre-billing reviews within twenty-four (24) hours of initial coding so accounts can be final billed as soon as possible. Chart reviews may not be limited to inpatient cases and may also include review of same day surgery/same day medical coding accuracy as needed.
The Contractor will participate in review of all mortality accounts on a pre-billing basis to ensure all possible diagnoses that affect mortality index are captured and that queries are issued as appropriate.
As requested, the Contractor will pre-review all accounts forwarded to physicians with queries to ensure queries are appropriate.
The Contractor will follow-up on answered queries and finalize coding and abstract completion based on physician response as appropriate.
The Contractor will assist with 100% pre-billing review of any new coders’ work as assigned. The Contractor must provide direct written feedback to coder(s) related to any coding errors and DRG changes identified according to established departmental communication channels.
The hospital does not measure accuracy based solely on codes that effect DRG assignment. Whenever there is clinical evidence to support a more specific diagnosis or clinical evidence of an incomplete/missing diagnosis, it will be counted as an error regardless of the impact on the DRG (even if DRG is already optimized with a MCC or CC). Multiple CCs and MCCs impact the mortality index which the hospital strives to optimize.
Coding errors include: incorrect principal diagnosis, omitted procedure code, omitted diagnosis code, incorrect code choice, sequencing error, incorrect present on admission (POA) indicator.
The Contractor must follow and apply all established hospital coding guidelines. The hospital will provide the contractor with a copy of its coding guidelines and expects the contractor to consistently apply and conform to these guidelines. Coding Clinic and other resources and references are available online in the Clintegrity 360 encoder.
All cases are reviewed for ICD-10 coding accuracy utilizing the coding books/encoder, Coding Clinics and facility coding guidelines. The assigned DRG is also verified based on the coding review. This review includes verification of documentation by the attending physician and other treating physicians to support the coding of all diagnoses and procedures, DRG assignments, and POA assignments. This review does not include potential optimization based on missing documentation. The hospital captures up to 50 diagnoses and 50 procedures as appropriate to each record.
The Contractor will correspond via email with Patient Accounts and core measures abstractors regarding any questions related to codes submitted or claim errors. The Contractor needs to re-code/re-submit abstracts for rebilling if any changes or corrections are required.
The Contractor will collaborate with the CDCI section to ensure concurrent coding queries are appropriate and offer suggestions for change. The Contractor will provide education regarding specific coding guidelines or requirements for CDCI staff as needed. The Contractor will collaborate with the CDCI supervisor frequently; however, education sessions with the entire staff will occur quarterly or will depend on operational needs of the department.
The Contractor may be required to meet onsite with hospital and/or medical staff leadership to discuss medical record documentation issues that affect coding, reimbursement or quality metrics and/or provide physician documentation improvement sessions or other written materials as appropriate.
The Contractor may be required to provide expert guidance to Client coding management on existing and/or new coding guidelines and their interpretation and application. The Contractor may be asked to help evaluate coding software or other coding workflow enhancements.
The Contractor should suggest continuing education courses for Client coding staff as patterns or other issues are identified.
The Contractor may be asked by UH coding management to provide continuing education to the facility coding team on new and emerging topics or other areas deemed problematic or that would benefit from additional discussion.
The Contractor may be asked to research emerging/new technologies or treatment modalities being offered to Client patients and provide Client HIM with the associated and applicable coding and reporting guidelines.
Job Benefits
Becoming an AMN Healthcare professional gives you the incredible opportunity to gain critical career experience, work with new people, and earn a highly competitive salary—but the perks don't stop there. There are many additional benefits to enjoy, including:
- Medical, dental and vision benefits
- Earned time off and paid holidays
- Paid continuing education time
- 401(K) retirement planning
- Short-term disability, life insurance, paid jury duty
- Access to the largest network of facilities and providers in the country
- Industry experienced workforce management team
- Licensure and certification reimbursement
About the Company
At AMN Healthcare, we strive to be recognized as the most trusted, innovative, and influential force in helping healthcare organizations provide quality patient care that continually evolves to make healthcare more human, more effective, and more achievable.