Lehigh Valley Health Network
Ear • Nose and Throat (ENT and Otolaryngology) • Pulmonology • Endocrinology (Diabetes and Metabolism) • Rheumatology
10,000+ employees
⚕️ Healthcare Insurance
Senior DRG Validation Analyst
November 20
Lehigh Valley Health Network
Ear • Nose and Throat (ENT and Otolaryngology) • Pulmonology • Endocrinology (Diabetes and Metabolism) • Rheumatology
10,000+ employees
⚕️ Healthcare Insurance
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.
Apply NowSimilar Jobs
November 20
Consultant role focused on delivering Digital Health consulting services and optimizing client systems.
November 20
Create Learning Performance Dashboards using Quickbase at CVS Health. Collaborate with business partners to identify needs.
November 20
Join ATI Advisory as a Senior Data Analyst focusing on Medicare and Medicaid data. Contribute to healthcare reform through data analysis and client engagement.
November 20
Join Cresco Labs as a Senior Analyst, focusing on external financial reporting and analysis.
November 20
As a Senior Design & Usability Analyst at FIS, you will design user interfaces for fintech applications. This role includes managing design strategy and user needs analysis.