DIAGNOSIS RELATED GROUP SPECIALIST

SUMMARY OF POSITION:

The DRG Specialist provides expert level coding consultation and guidance for complex medical records that need research and reference checking; serves as a project leader for projects related to quality of ICD-10 coding and evaluation of  revenue impact; researches and advises HIM management regarding feasibility of coding products, educational tools, analyzes data to identify areas for improvement, oversees coding function in the absence of manager; assists in the orientation and education of  the coding staff. Provides responses to denials of payment, evaluates recommendations of  Coding Validation consultants.   Performs all duties of the Senior Medical Audit Analyst.  Serves as project leader for assigned areas of focus providing expertise and education of  staff in principles of ICD-10 and other coding classification guidelines to ensure staff is appropriately prepared to meet quality expectations. Review and appeal DRG denials received from CMS, NYS and other payers and review agencies.  Reviews, analyzes and monitors findings of external consultants. The DRG specialist must be able to critically review the denial and provide appropriate rationale to argue the denial and  recoup reimbursement. Educates HIM associates on clinical documentation opportunities, coding quality improvement strategies.   Reinforce education to coding staff at all levels to ensure up-to-date on knowledge on vagaries of documentation and complexities of diagnoses and procedure documentation Performs related work as required.

EDUCATION AND REQUIREMENTS:

High School Diploma/GED is required, Bachelor's Degree is preferred.

Certification by recognized national organization including:  RHIA  RHIT  CCS  CTR  CPC Required 

Department: Health Information Management Bargaining Unit: Non Union Campus: TARRYTOWN  Employment Status: Regular Full-Time Address: 555 South Broadway, Tarrytown
Shift: Day Scheduled Hours: 8:30 AM-5 PM Req ID: 212849 Salary Range/Pay Rate: $92,250.00  $123,000.00    

For positions that have only a rate listed, the displayed rate is the hiring rate but could be subject to change based on shift differential, experience, education or other relevant factors.

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Diversity, equity and inclusion are core values of Montefiore. We are committed to recruiting and creating an environment in which associates feel empowered to thrive and be their authentic selves through our inclusive culture. We welcome your interest and invite you to join us.

Montefiore is an equal employment opportunity employer. Montefiore will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law. 

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