DRG Validation Auditor

Position Summary

The DRG Validation Auditor is responsible for ensuring the integrity of inpatient medical records by auditing them to confirm that clinical documentation accurately supports the condition and DRG billed and reimbursed. This position requires a detailed understanding of medical coding principles, coding guidelines, coding clinics and the ability to perform objective medical audits. The auditor will analyze and audit claims, drawing on advanced ICD-10 coding expertise and guidelines to substantiate their conclusions.

In this role, the auditor will utilize various audit tools, resources, and workflows to generate audit determinations and formulate detailed audit findings letter within the appropriate timeframe as indicated by each payor. The auditor will be responsible for reviewing all DRG denials for all payors across ECU Health. The auditor will also be responsible for identifying potential documentation and coding errors that could potentially help reduce additional denials for the organization.

The DRG Validation Auditor will also conduct focus reviews identified by Quality, Compliance and Center Billing Office. The auditor must be task oriented and have strong ability to work independently on assigned tasks. The auditor will work in conjunction with physician advisors, HIMS leadership and other appropriate staff to coordinate and perform internal audits and make recommendations to ensure compliance with Federal and State regulations and OIG compliance guidelines.

Assist with other audits within Streamline eValuator and/or coding as needed.

• Analyze and audit claims by integrating medical chart coding principles and guidelines.
• Proficiency in DRG assignments, ICD-10 CM, ICD-10-PCS, official coding guidelines, medical terminology, human anatomy and physiology, pathophysiology, pharmacology, and proficiency in Microsoft Office products (Word and Excel).
• Generate audit determinations and compile detailed audit findings letters.
• Excellent verbal and written communication skills.
• Writes clear, accurate and concise recommendations in support of findings while providing feedback and education to the coders, referencing current ICD-10-CM/PCS Official Coding Guidelines and AHA Coding Clinics.
• Ability to work independently and exercise independent judgment.
• Critical thinking skills.
• Research coding questions asked by coding and other areas in a timely manner.
• Must have knowledge of the Clinical Documentation Management Program and assist the Documentation Specialist with questions regarding code/DRG assignment.
• Serves as back up for the Coding Specialist II, Coding Specialist III and Coding Auditor when needed.
• Make recommendations on coding education and training based on audit results.
• Other duties and responsibilities, as assigned.
• Maintains AHIMA credentials, CEUs and up to date knowledge of coding guidelines.

• Associate or Bachelors degree in AHIMA accredited Health Information Management program with credentialing as a RHIA or RHIT. An AHIMA certified Coding Specialist (CCS) credential may be substituted in lieu of a degree.
• 5 years' experience.
• Prior coding auditor experience is preferred but not a requirement.

• Remote role (based out of Greenville, NC)
• Monday - Friday day shift:
• 8:00 a.m.
  
  - 4:00 p.m.
• Great Benefits

ECU Health

About ECU Health

ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations.

The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Childrens Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care, education and research.

General Statement

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