DRG Coding Validator

Job Summary

The Clinical Documentation Improvement (CDI) Coding Specialist is responsible for reviewing medical records to facilitate the accurate representation of the severity of illness by improving the quality of the physicians’ clinical documentation. This involves extensive record review, interaction with physicians, coding professionals, nursing, and case management staffs at Kent Hospital and Women and Infants Hospital.

Duties and Responsibilities

Demonstrates a comprehensive, expert-level of knowledge of all procedures concerning the sequencing of diagnoses, procedures including, but not limited to, those outlined in ICD-10-CM/PCS Uniform Hospital Discharge Data Set, Medicare guidelines and other appropriate classification systems. Ensures correct use by the coding staff.

Facilitates necessary documentation in the medical record through extensive interaction with physicians, nursing staff, other patient caregivers, and collaboration with coding staff.

Ensures the accuracy and completeness of clinical information used for measuring and reporting.

Oversees clinical documentation patterns and trends to identify areas of improvement

Educates all members of the patient care team regarding clinical documentation needs, changes to guidelines, coding and reimbursement issues.

Develops and conducts continuous Performance Documentation education for new staff

Compiles, analyzes and evaluates quality and clinical data collected as part of an integrated system-wide program of clinical improvement and documentation requirements.

Gathers and interprets clinical documentation data, to identify discrepancies, problems or issues.

Uses assertive interpersonal skills to discuss clinical documentation issues and work effectively with all levels of internal personnel such as coders, physicians, nursing and case managers

Articulates the program to physician and other health care professionals in order to educate and teach clinical documentation requirements.

Conducts DRG validation and develops effective verbal and written physician queries.

Participates in external reviews such as, Recovery Auditors, and develops written appeals as needed.

Performs other related duties as assigned.

Requirements

High School Diploma with a minimum of 5 -7 years Coding experience in an acute healthcare environment required.

Certification as a Certified Coding Specialist (CCS) required.

Certified Documentation Integrity provider (CDIP) or Certifed Clinical documentation specialist (CCDS) preferred.

Excellent oral and written skills and knowledge and ability to collaborate with clinical, operational and financial areas required.

Care New England Health System (CNE) and its member institutions—Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, and our Wellness Center—are trusted organizations fueling the latest advances in medical research, attracting the nation’s top specialty-trained doctors, and honing renowned services and innovative programs to engage in the important discussions people need to have about their health.

Americans with Disability Act Statement: External and internal applicants, as well as position incumbents who become disabled must be able to perform the essential job-specific functions either unaided or with the assistance of a reasonable accommodation, to be determined by the organization on a case-by-case basis.

EEOC Statement: Care New England is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status

Ethics Statement: Employee conducts himself/herself consistent with the ethical standards of the organization including, but not limited to hospital policy, mission, vision, and values.