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Posted: Tuesday, February 20, 2018 12:09 AM


Job Description:

Performs DRG/Coding Validation for quality. Reviews records coded by the coding staff, to validate the ICD-10-CM, CPT, and DRG assignment to ensure consistency and efficiency in inpatient and outpatient claims processing and data collection for the hospital.
Demonstrates knowledge of the DRG and APC classification system and its impact on reimbursement and keeps abreast of the latest revisions to Federal Regulations. Understands disease process and fundamentals of medicine

Reviews DNFC “Unbilled Report” daily and review charts as necessary.
Consults with physician as needed for diagnosis completion or clarification.
Reviews and evaluates DRG claim denials and rejections. Responds to the PRO DRG changes, RAC Audits, Blue Cross Audits, OP Medical Necessity denials, Medicare CCI edits and all other pertinent denial notices. Reviews with Director of HIM and Denials Team, prepares appeal letters, identifying appropriate documentation and references when appropriate.
Acts as a contact person for the concurrent review process conducted by the Clinical Documentation Improvement (CDI) Specialist for coding questions, DRG assignments, and provides education for coding /DRG changes found in the random/ focused review and quarterly coding changes.

Demonstrates competency in the use of computer applications and DRG Grouper software, 3M Encoder, Meditech, Craneware, Medicare edits and all coding and abstracting software currently in use in the Health Information Management department.
Recognizes and understands the role of a coder in the department and how it relates to the overall function of the hospital revenue cycle regarding patient care, case-mix, and fiscal reimbursement.

Performs annual appraisals of all HIM coding staff. (6.5 FTEs)

Job Requirements:

• Must be a graduate of an accredited Registered Health Information Technician Program or Registered Health Information Administration Program and/or other related healthcare field.
• Maintain valid license/certification required for job. : Must meet continuing education requirements of 20 hours per 2 year cycle submitted to the American Health Information Management Association to maintain RHIT credentials/ 30 for RHIA.


• 2 - 3 years HIM and coding experience required. DRG/Inpatient Coding experience and audit experience/Knowledge required.
• Experience in medical records management in acute care setting preferred.
• Must be able to read, write, interpret and communicate simple and complex instructions and exercise critical thinking skills independently.
• Experience with 3M Coding and Reimbursement System and Microsoft Office products, including Excel, Access, PowerPoint, preferred.


Contact Person: Lisa Foster
Email Address:
Phone: 2708277542

• Location: Henderson, KY, Western Kentucky

• Post ID: 18625492 kentucky is an interactive computer service that enables access by multiple users and should not be treated as the publisher or speaker of any information provided by another information content provider. © 2018