Description

The Inpatient Auditing Specialist performs Diagnostic Related Group (DRG) validation and quality audits on Inpatient. The Coding Quality Expert will perform the chart reviews in collaboration with and alongside fellow team members consisting of Physician Reviewer. This team is referred to as The Tower.

The Tower will utilize International Classification of Diseases and Physicians Current Procedural Terminology to ensure accurate coding. They will support CorroHealth in denial reviews, In Patient, CDI, Pro Fee, and Milliman Care and InterQual guidelines.

• Responsible for validating proper sequencing and accuracy of ICD-10-CM/PCS codes, POA assignments, and other coding factors.
• Usage of most current Clinical Criteria, MCG, InterQual, payers’ Clinical Policy Bulletins, CMS Guidelines, NCDs and/or LCDs
• Maintaining compliance in turnaround time requirements as mandated by the TAT Standards of the facility and/or CorroHealth standards
• Support CorroHealth in developing accurate training materials
• Provide training within the tower to team members and to new hires
• Assist CorroHealth with project data analysis, reporting, and feedback internally and externally to CorroHealth clients
• Maintain professional etiquette within The Tower
• Works directly with clients, CDI Specialist, MD Physician Reviewers and CorroHealth Leadership
• Ensures all PHI is appropriately stored and delivered to authorized individuals
• Meets or exceeds production and quality metrics
• Attend all mandatory meetings and trainings
• All other position related duties as delegated by management

Experience/Skills/Certification Requirements:

• Must have a CCS credential, from AHIMA
• 3 years minimum, DRG Validation Auditing experience
• Knowledge of CMS, State Regulations, ICD-10-CM/PCS, CPT, and Coding Clinic Guidelines
• Experience in computer skills, Word, Excel, Outlook, experience working in a health plan medical management documentation system a plus.
• CDI experience, inpatient coding experience, inpatient facility coding,
• Need to be a strong Inpatient FAC coder and have experience with DRG coding and audits

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The list below is representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Requirements

ESSENTIAL DUTIES AND RESPONSIBILITIES: 
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.