Job Description

UPMC Corporate Revenue Cycle is hiring a DRG Specialist to work on inpatient auditing within our Coding Department. This position will be a work-from-home position working during standard business hours Monday through Friday.

In this role, you will r eview clinical documentation within the medical record to ensure that all patient resource utilization, principal diagnosis, secondary diagnoses, and PCS procedures have been coded accurately and completely in compliance with coding guidelines, third party payer and OIG regulations.

Responsibilities:

• Focus emphasis of educational communications on accurate and thorough documentation necessary to support the coding of diagnoses that were treated, monitored and evaluated and procedures that were performed during an episode of care.
• Review and evaluate focused UPMC DRG medical records for accurate DRG assignment to ensure that all documented principal and secondary diagnoses, including all complications and co-morbidities, and procedures are accurately coded and sequenced according to coding and compliance guidelines.
• Formulate physician queries that present indications, utilizing clinical judgment, of a diagnosis that is not clearly documented in the medical record and request appropriate documentation to support the additional diagnosis.
• Identify and report issues and trends to the coding management. Prepare and present training when requested on accurate DRG assignment for coding, CDI, and management personnel
• Assists with training of new DRG Specialists and coders as requested
• Provide coding staff with education, on a case level on any coding issues identified during reviews. Counsel/train coders on problems when necessary in coordination with the Coding Manager and assist in correcting deficiencies in DRG assignment.
• When requested, investigate, correct (if necessary), and respond to requests for record review relative to discharge disposition, admit or discharge date, invalid codes, etc. from requesting departments to ensure timely, accurate reimbursement.
• Function as a resource person to respond to special audits and projects assigned by Management or requested by other departments. Perform audits as requested by internal departments and outside payers/agencies. Attend and participate in meetings as requested.

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