DRG Integrity Specialist
Shepherd Center

About Shepherd Center

With five decades of experience, Shepherd Center provides world-class clinical care, research, and family support for people experiencing the most complex conditions, including spinal cord and brain injuries, multi-trauma, traumatic amputations, stroke, multiple sclerosis, and pain. An elite center ranked by" U.S. News "as one of the nation's top hospitals for rehabilitation, Shepherd Center is also recognized as both Spinal Cord Injury and Traumatic Brain Injury Model Systems. Shepherd is the only rehabilitation facility in the nation with an intensive care unit on-site, allowing us to care for the most complex patients and begin the rehabilitation process sooner. Shepherd Center treats thousands of patients annually with unmatched expertise and unwavering compassion to help them begin again.

Shepherd Center's culture is one of hope, humor, and hard work. You will enjoy career growth, strong relationships with co-workers , strong support from leadership, and fun activities that have ke pt over 1 2% of staff members working at Shepherd for more than 20 years .

The DRG Integrity Specialist performs a secondary level review of medical records and code assignment using knowledge of Accuity technology and client systems with a physician in accordance with federal coding regulations and guidelines as well as client specific coding guidelines to ensure accurate DRG assignment. This function requires a broad knowledge of the compliance structure to support the proper reimbursement.

• Review pre-bill cases simultaneously with a physician and/or mid-level provider during each work shift excluding breaks and meetings to analyze and validate diagnosis and procedure codes for inpatient services via coding compliance and clinical knowledge to support accurate DRG assignment.
• Utilizes technology for tracking coding errors, query opportunities and other data collection as needed.
• Researches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, and client denials.
• Possesses an elevated level of dependability and ability to meet coding recommendations, accuracy rate, and production standards.
• Interacts with physicians, peers, CDIS, and management regarding documentation, policies, procedures, and regulations.
• Interacts with management on an ongoing basis in supplying recommendations for process improvement so that productivity and quality goals can be met or exceeded, and operational efficiency and financial accuracy can be achieved.
• Reviews, develops, modifies, and/or adapts relevant client procedures, protocols, and systems to coordinate with methodology.
• Creates and provides group education and training based on accurate coding practices, coding compliance documentation, and regulatory provisions.
• Attends in-house training sessions to receive updated coding information and changes in coding and/or regulations.
• Adheres to stringent timelines consistent with project deadlines and directives.
• Ensures strict confidentiality of patient medical records.
• Codes medical records as needed based on organizational needs.
• Performs miscellaneous job-related duties as assigned.

REQUIRED MINIMUM EDUCATION:

• High school diploma or equivalent.

REQUIRED MINIMUM CERTIFICATIONS:

• Coding credential required from AHIMA/AAPC (RHIA, RHIT, CCS and/or CPC).

REQUIRED MINIMUM EXPERIENCE:

• Minimum 4 years of inpatient coding experience in hospital facility coding
• Minimum 2 years of experience that is directly related to the duties and responsibilities specified above
• Experience and knowledge in DRG reimbursement (i.e., MS-DRG, APR-DRG)

REQUIRED MINIMUM SKILLS:

• Knowledge of auditing concepts and principles.
• Expert of coding guidelines.
• Ability to use independent judgment and to manage and impart confidential information.
• Advanced knowledge of medical coding, electronic medical record systems, coding systems.
• Critical thinking skills to analyze and solve problems.
• Effective communication and interpersonal skills.
• Knowledge of legal, regulatory, and policy compliance issues related to medical coding and documentation.
• Knowledge of current and developing issues and trends in medical coding diagnosis and procedure code assignment
• Ability to clearly communicate medical information to physicians and CDIS staff.
• Ability to supply guidance and training to when needed.
• Ability to use a PC in a Windows environment, including MS Word.
• Independent, focused individual able to work remotely or on-site.

PREFERRED QUALIFICATIONS:

• Associates Degree in Health Information Management or similar preferred.

PHYSICAL DEMANDS :

• Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time or exerting up to 15 pounds of force occasionally or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body.

WORKING CONDITIONS:

• No potential for exposure to blood and body fluids.

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