Senior DRG Validation Analyst

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Lehigh Valley Health Network

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Ear • Nose and Throat (ENT and Otolaryngology) • Pulmonology • Endocrinology (Diabetes and Metabolism) • Rheumatology

10,000+

Description

• Develops, implements, and maintains a coding and reimbursement quality management plan at the network level. • Trains and educates coding and clinical staff. • Serves as a coding resource for the organization. • Utilizes output for financial and billing purposes to meet licensure requirements, network quality initiatives, and public hospital and physician reporting. • Performs coding, monitoring, and auditing activities providing individual, departmental, and topic related results according to established schedule. • Conducts formal education and training for staff on policies/procedures, coding guidelines, regulatory requirements, and work processes. • Provides feedback and develops educational action plans. • Establishes, implements, and maintains a formalized review process to support coding compliance. • Supports the manager in ensuring the completion of training of new employees and ongoing training of current employees. • Researches and responds to questions from the coding staff. • Evaluates the quality of clinical documentation to spot incomplete or inconsistent documentation impacting code selection. • Anticipates documentation issues in response to upcoming regulatory updates. • Maintains database for internal reporting of quality outcomes. • Demonstrates a clear understanding of purpose and objectives of department by keeping alert on current practices through journals, networking, and continuing education.

Requirements

• High School Diploma/GED • 4 years of experience in coding/abstracting of complex patient encounters. • Microsoft Office and presentation skills. • Medical terminology, anatomy and physiology, pathophysiology, regulatory agency requirements, severity of illness classification, and health care statistics computation. • Knowledge of ICD-10-CM/PCS, HCPCs/CPT, modifiers, charge applications, and reimbursement methodologies (DRG, APC). • Demonstrated leadership and presentation skills. • CCA - Certified Coding Associate AHIMA - State of Pennsylvania Upon Hire • CCS - Certified Coding Specialist AHIMA - State of Pennsylvania • CCS-P - Certified Coding Specialist-Physician Based AHIMA - State of Pennsylvania • CPC - Certified Professional Coder - State of Pennsylvania • CPC-H-Certified Professional Coder-Hospital AAPC - State of Pennsylvania • Associate’s Degree in healthcare related field.