DIAGNOSIS RELATED GROUP SPECIALIST

The DRG Specialist provides expert level coding consultation and guidance for complex medical records that require research and interpretation of clinical documentation; 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 all levels of appeal to DRG based denials of payment and prepares documents for Administrative Law Judge as required to obtain payment;  evaluates recommendations of  external consultants on coding validation results.   Performs all duties of the Senior Medical Audit Analyst.  Performs related work as required

EDUCATION/SKILLS:

Bachelor’s degree in a health-related field or significant work experience appropriate to carry out the responsibilities of this position preferred. 
Expert clinical knowledge to analyze a medical record.  Prior clinical experience with a documentation improvement program is a plus. 

Certification by recognized national organization including:  RHIA  RHIT  CCS  CPC Required 
Candidates must have satisfactorily completed an industry recognized curriculum in Coding using ICD -10CM, ICD-10 PCS/CPT4
Knowledge of the elements of disease processes and related procedures.
Ability to build effective partnering relationships with providers and other clinical staff, Finance and payer representatives to problem solve and improve quality 
Knowledge of various DRG groupings and reimbursement methodologies 
Excellent critical thinking, analytical, verbal and written communication skills.  Experience in writing denial appeals a plus
Basic computer skills and knowledge of word processing, spreadsheet and database programs. 
Strong organizational and time management skills
Ability to multi-task and meet targets 

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: 223512 Salary Range/Pay Rate: $93,750.00 - $125,000.00    

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.

To learn more about the “Montefiore Difference” – who we are at Montefiore and all that we have to offer our associates, please click here.  

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. 

N/A