Inpatient Drug Auditor

Job Description

Overview

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.

The Inpatient DRG Validator is a vital role within the Inpatient Coding Department. This position supports the Inpatient Coding Department and external customers as a coding content expert, educator, and resource expert in the selection of the correct Diagnostic Related Group (DRG), diagnosis and/or procedure codes for inpatient admissions. Responsibilities include activities contributing to the overall success of the Inpatient Coding Department as well as the health system.

EEO/AA/Disability/Veteran

Responsibilities

• 1. Coding Compliance and Risk Reduction - Understands the financial impact of their primary duties, identifies risk areas and works towards preventative strategies.
• 1.1 Analyses cases that are returned to coding for reviews from other partner departments (i.e. Billing, Denials, Payer Audit, CDI, etc.). Completes all records from assigned work queues daily.
• 2. Coding Expectations - Expected to code a portion of their time to remain relevant within the field.
• 2.1 Maintains a minimum of 95% in coding quality scores for DRG validation as well as Total Data Quality.
• 3. Content Knowledge - Maintains industry specific certifications and remains up to date on changes within in the industry.
• 3.1 Maintains Certified Coding Specialist (CCS) designation per the guidelines set forth by the American Health Information Management Association.
• 4. Education - Leads by example and passes knowledge onto less experienced coders.
• 4.1 Provides answers to coding questions from internal partners (billing, payer audit, etc.), as well as provides sound rationales for the suggested coding adjustment through the use of the coding tabular, UHDDS guidelines, Coding Clinics and other resources as needed.
• 5. Problem Solving - Demonstrates flexibility and critical thinking throughout their workflow.
• 5.1 Troubleshoots billing issues in collaboration with billing staff and ensures the coding is correct per coding guidelines.
• 6. Reporting - Provides leadership data and reports occasionally.
• 6.1 Presents data clearly and consistently to a departmental standard.
• 7. Standards of Performance & Communication - All YNHH employees are expected to demonstrate professional behavior and respect in all their interactions.
• 7.1 Adheres to Yale New Haven Health Standards of Professional Behavior: Patient-Centered Care, Respect, Compassion, Integrity, and Accountability.

Qualifications

EDUCATION

High School diploma or GED required. Bachelor's Degree with additional training in medical terminology, anatomy, and physiology or enrolled in a Bachelor program strongly preferred. Certified Coding Specialist (CCS) certification through the American Health Information Management Association (AHIMA) required. RHIT/RHIA preferred.

EXPERIENCE

Minimum of five (5) to eight (8) years' experience coding inpatient medical records. Actively involved in coding activities since implementation of ICD-10. Experience with payer audits, denials, rejections helpful.

LICENSURE

Certified Coding Specialist (CCS) certification through the American Health Information Management Association (AHIMA) required. RHIT/RHIA preferred.

SPECIAL SKILLS

Ability to prioritize and organize the work of other. In-depth knowledge of medical terminology, anatomy, and physiology. Comprehensive understanding in use of ICD-10. Excellent oral and written communication skills, ability to exercise good judgment. Knowledge of personal computers and related software. Ability to train new and existing staff members in the application of all coding systems, as well as knowledge of the PPS system (DRGs and APCs) and ability to resolve coding and billing issues as it relates to the above. Knowledge of current and developing issues and trends in medical coding diagnosis and procedure code assignment.