Location: Montebello, New York
The DRG Coordinator coding is responsible for ensuring efficiency in inpatient coded and abstracted data collection to optimize DRG reimbursement with direct reflection in the Case Mix Index (CMI) calculation while complying with federal, state, and payer-specific regulations and policies pertaining to documentation, coding and billing. This position utilizes continuous improvement principles to support Coding processes and functions with direct impact on the BSCHS Revenue Cycle activities and outcomes.
- Develops a collaborative CDMP team in order to maintain a positive open communication environment with physicians, interdisciplinary care team members and department managers.
- Facilitates appropriate clinical documentation to ensure medical records are accurate and recommends improvements/documentation guidance to the CDMP and medical staff when necessary.
- Develops and conducts ongoing clinical documentation management education for all new staff, including new clinical documentation specialists, physicians, nursing and allied health professionals.
- Educates all internal and external customers on clinical documentation opportunities, coding and reimbursement issues as well as performance improvement methodologies.
- Reviews clinical issues with the coding staff to assign as working DRG, resolve discrepancies in the final DRG and provides ongoing feedback to the CDMP staff.
- Develops initiatives to support CDMP strategies and opportunities while setting goals to manage financial and material resources. Participates in system wide initiatives especially VBP, SOI, ROM, and ICD 10.
- Coordinates the BSCHS ICD-10 Coding Training Program.
- Assists in the developing ICD-10 Physician Documentation Improvement Programs and ensures compliance with ICD-10 coding guidelines related to the BSCHS Revenue Cycle activity.
- Develops reports, collects and prepares data for studies involving inpatient stays for clinical evaluation purposes and financial impact and profitability.
- Initiates corrective actions to ensure resolution of problem areas identified during an internal investigation or auditing/monitoring activity.
- Performs periodic claim form reviews to check code transfer accuracy from the abstracting system and the CDM.
- Evaluates records and responds to the Quality Improvement Organization (QIO) DRG change and denial notices.
- Supports Accounts Receivable management best practices by providing coding expertise in inpatient/outpatient claims reconciliation.
- Participates in budget preparation as requested. Performs other duties as assigned.
Requires minimum of five (5) years of progressive coding (inpatient and outpatient) or coding review experience in ICD-10-CM and CPT-4, DRG/APC optimization with claims processing. Inpatient PCS competency required. ICD-10 Certified Trainer and data management responsibilities a plus. Proficient user of Coding and Abstracting Information Systems and data reporting applications. Previous experience in an electronic medical record environment (EPIC) and Computer Assisted Coding Applications, with strong ad hoc reporting capabilities preferred. Certified Coding Specialist (CCS) coding certification from the American Health Information Management Association (AHIMA) required. Knowledge of disease process as well as anatomy and physiology.
Bachelor's degree, required.
If applicable, the individual performing this job may reasonably anticipate coming into contact with human blood and other potentially infectious materials. Individuals in this position are required to exercise universal precautions, use personal protective equipment and devices, and learn the policies concerning infection control.
Good Samaritan Hospital
Good Samaritan Hospital in Suffern, NY, is a 286-bed hospital providing emergency, medical, surgical, obstetrical/gynecological and acute-care services to residents of Rockland and southern Orange counties in New York; and northern Bergen County, NJ. The hospital is home to a recognized cardiovascular program, comprehensive cancer-treatment services, the area's leading Wound and Hyperbaric Institute and outstanding maternal/child services that includes a Children's Diagnostic Center. Good Samaritan Hospital also provides social, psychiatric and substance-abuse services and its certified home-care agency supports residents of the Hudson Valley and beyond.