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Beskrivning av tjänsten:
CGI is offering an opportunity to join a proven team of audit professionals. As a member of CGI’s DRG Validation Team, incumbents will be responsible for reviewing medical records to determine the accuracy of coding and reimbursement for clinical services rendered to beneficiaries of various health plans, including Commercial, Medicare, and Medicaid Clients. DRG Validation Auditors are charged with rendering appropriate, well-supported, and thoroughly-documented decisions, which may result in identification of improper payments (overpayments and underpayments) on paid claims on behalf of the client from various providers of clinical services, including but not limited to acute care, long-term acute care, acute rehabilitation, and skilled nursing facilities, as well as other provider types and care settings. Initially, DRG Validation Auditors are prepared for the role through a detailed, well-defined training process, gaining knowledge and skills in methods for review of medical records and other provider documentation. Ongoing training and education are provided specific to audit processes, coding and reimbursement changes, and other topics as well. The DRG Validation Auditor reports to a DRG Validation Team Leader, who provides support, feedback, and guidance to DRG Validation Auditors. Moreover, quality assurance is provided through a well-defined review and quality management program performed by the Professional Development Team.
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Dina framtida arbetsuppgifter:
-Review inpatient medical records to validate the admit order, assignment and sequencing of ICD9-CM diagnosis and procedure codes, discharge status codes, and DRG assignment.
- Provide a detailed rationale for every medical record review resulting in a DRG Review Results letter, including supporting references. - Follow proper procedure for referral to Clinical Nurse Auditor or Physician Advisor. - Utilize proper reference material, standards, and guidelines for coding. - Provide input to the Edit Development team on claims selection criteria. - Verify data received from client and work to resolve discrepancies. - If the contract requires onsite review, interact with Providers and other personnel in a professional manner. - Follow CGI Federal policies and processes - Comply with department standards regarding productivity and audit quality. - Perform other duties as assigned.
Kvalifikationer för att bli framgångsrik i denna roll:
To be considered for these challenging roles, applicants must have a majority of the following skills, knowledge and abilities:
- Possesses current AHIMA credentials (RHIT/RHIA/CCS), with current CCS preferred - Demonstrate extensive knowledge of ICD-9-CM coding and DRG reimbursement, with a minimum of five years of inpatient coding experience (previous experience training and mentoring junior-level coders is highly desired) - Have an understanding of Medicare, Medicaid, and commercial provider reimbursement methodologies, and possess strong data analysis skills - Working knowledge of computer functions and applications such as Microsoft Office (Outlook, Word, Excel) and Windows operating systems - Ability to write a well-reasoned review in a narrative style, with accurate spelling, grammar, punctuation, and sentence structure -Ability to adapt to changing priorities in order to meet Client requirements and productivity standards and deadlines -Ability to travel for additional training and on-site reviews on an as-needed basis - Since incumbents will work from a home-based office, they must have their own access to high-speed Internet connectivity.
Health Care Payers Health Insurance ICD-9-CM Coding System Microsoft Office
Vad du kan förvänta dig av oss:
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