Remote DRG Validator

QualCode, Inc.

Introduction:

QualCode, Inc. is currently seeking an experienced Remote DRG Validator to join their team in New York, NY.

About Us: For over 15 years QualCode has been providing medical coding, coding education and compliance auditing services for healthcare providers to maximize their revenue while keeping them in compliance with federal and state regulations.

We offer flexible onsite and remote services to help our clients eliminate coding backlogs, reduce RAC exposure, recover lost revenue through DRG/coding and compliance audits and boost efficiency with expert staff training and coding education services.

Job Description:

  • Perform remote review of selected inpatient discharges from Client’s editing program for DRG validation purposes utilizing Client’s encoder software, clinical information system and abstracting system
  • Perform a comprehensive review of the inpatient discharges to confirm:
  • Correct principal diagnosis selection and to check if co-existing diagnoses exist during the time of the admission
  • Appropriate secondary diagnoses including, but not limited to, complications, co-morbidities, and major CC’s
  • Correct procedure code(s) selection
  • Proper sequencing
  • Accuracy of Hospital Acquired Condition (HAC) code
  • Severity of Illness (SOI) and Risk of Mortality (ROM) classification validation
  • Present On Admission (POA) indicator
  • Correct discharge status
  • Perform the review based on AHA Coding Clinic for ICD-10-CM guidelines, CMS ICD-10-CM and ICD-10-PCS Official Guidelines for Coding and Reporting, and Uniform Hospital Discharge Data Set definitions
  • Assess if the clinical documentation supports the diagnoses and procedure codes reported
  • Enter coding changes found into internal database tracking system
  • Release all change discharges in Client’s abstracting system and/or DRG editing system
  • Display a positive attitude within the organization in support of the organization’s programs and mission
  • Promotes effective working relations and works effectively as part of a department/unit team to facilitate goals and objectives
  • Maintains confidentiality of all hospital and patient information (HIM duty)


Education and Experience:

  • High School diploma or equivalent
  • RHIA, RHIT, CCS or CPC credential
  • 3 – 5 years’ of inpatient coding and DRG validation experience in an acute care setting


Skills and Abilities:

  • Extensive knowledge of AHA coding guidelines and ICD-10-CM/PCS coding system
  • Knowledge of MS-DRG, NYS-APR, and NYS-AP-DRG grouper logic, and CMS regulations is required
  • Strong analytical and communication skills with attention to detail
  • Ability to work independently under minimal supervision
  • PC proficient, having a functional knowledge of facility EMR, encoder, and other support software

Compensation/Benefits:

  • $95,000 – $100,000; commensurate with experience
  • Medical/Dental/Vision
  • 401K Plan
  • Paid Time Off (PTO)

Instructions for Resume Submission:

Please submit your resume via email to Thomas Sanders tsanders@qualcodeinc.com