Remote DRG Validator (RN)

Full-time | Part-time | Remote | Permanent

Managed Resources is a leading consulting group assisting healthcare organizations nationwide in optimizing its revenue cycle management through review, recovery and educational programs. Please read the below description and apply if you meet the requirements and would like to hear more about this opportunity with Managed Resources!

The CDI & DRG Specialist plays a crucial role in bridging the gap between clinical documentation and coding accuracy. They collaborate with payers (Medicare, Commercial, and Third Party) to review and analyze denied/downgraded MS-DRG and APR-DRG accounts to ensure that clinical documentation accurately reflects the severity of illness, intensity of services provided, and level of care rendered to patients.

Reports to:

Manager of Clinical Appeals

Essential Job Functions

Clinical Documentation Improvement (CDI):

• Review inpatient medical records to ensure completeness, accuracy, and compliance with coding guidelines and regulatory requirements.
• Work closely with healthcare providers to clarify ambiguous or incomplete documentation through concurrent and retrospective chart reviews.
• Educate physicians, nurses, and other healthcare professionals on proper documentation practices to capture the severity of illness, risk of mortality, and complexity of care provided.
• Identify opportunities for improvement in clinical documentation processes and implement solutions to enhance accuracy and efficiency.

Diagnosis Related Group (DRG) Validation:

• Assign appropriate DRGs to patient cases based on documented diagnoses, procedures, and patient status.
• Validate DRG assignments for accuracy and compliance with regulatory guidelines, ensuring appropriate reimbursement and risk adjustment.
• Analyze DRG data trends and collaborate with coding and billing teams to address discrepancies and optimize reimbursement outcomes.

Coding Compliance and Auditing:

• Conduct regular audits of coded medical records to assess coding accuracy, completeness, and compliance with coding guidelines, including ICD-10-CM/PCS and CPT/HCPCS.
• Provide feedback and education to coding staff regarding coding errors, documentation deficiencies, and coding guidelines updates.
• Assist in resolving coding-related denials and appeals by providing supporting documentation and clinical validation.

Quality Improvement Initiatives:

• Participate in quality improvement initiatives related to clinical documentation, coding, and reimbursement to enhance patient care outcomes and financial performance.
• Collaborate with interdisciplinary teams to develop and implement best practices for documentation improvement and coding accuracy.
• Monitor key performance indicators (KPIs) related to CDI and DRG accuracy and effectiveness, and implement strategies to achieve performance goals.

Education and Experience:

• Registered Nurse (RN) License is required.
• CCS, CPC, CCDS, or RHIT Certification is required.
• Graduate of an accredited College or University, BSN is preferred.
• 5+ years of clinical experience in Hospital inpatient and outpatient departments.
• 2+ years of clinical appeals/denials writing experience.
• Experience reviewing and analyzing denied/downgraded MS-DRG and APR-DRG and APC medical records and accounts received from payers (e.g., Medicare, Commercial, and Third Party).
• Experience in a variety of Electronic Medical Records (EMR) Systems, i.e. (3M, Nuance, Epic, etc).

Ideal candidate will possess the following:

• Excellent verbal and written communication skills.
• Excellent computer (Word, Excel, Skype, Dual Screens, etc.) skills.
• Excellent organizational and time management skills with a strong focus on detail and the ability to work remotely in an environment where HIPAA regulations can be enforced.

Preferred:

• 2+ years of medical coding experience for inpatient and outpatient.
• 2+ years of Clinical Documentation Improvement (CDI) experience .

Check Out Our Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Referral program
• Vision insurance
• Pet Insurance
• Monthly Internet Stipend

Our Vision: To become the most trusted, innovative and consultative revenue cycle partner in the nation.

Managed Resources is an Equal Opportunity Employer (EOE) M/F/D/V/SO

Visit http://jobs.managedresourcesinc.com to find more jobs and sign up for job alerts.

Job Types: Full-time, Part-time

Work setting:

• Remote

Experience:

• Inpatient & Outpatient Coding: 2 years (Required)
• Clinical Appeals/Denials writing: 2 years (Required)
• Inpatient & Outpatient Hospital: 5 years (Required)

License/Certification:

• CCS, CPC, RHIT, or CCDS Certification (Required)

Work Location: Remote