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DRG/APG Reviewer

  • Location: New York, NY
  • Job Type: Direct Placement
  • Ref No: 19-01986
  • Date: March 22, 2019
  • Job title:

 

 

Scott Smith

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Job Description - DRG/APG Reviewer

Position Summary:

  DRG/APG Validators review charts on behalf of our clients to assist in cost containment. Organizations approach is to chart review encompasses coding guidelines and clinical evaluation with a goal towards eliminating unjustified overpayment. 



Requirements:

  • Ability to prioritize and organize workload and complete tasks independently
  • Ability to communicate effectively both orally and in writing
  • Knowledge of various computer software programs and able to demonstrate computer skills
  • Individual must have a minimum of three years' experience in DRG Validation/Claims/Inpatient coding
  • Required Certifications ICD-10-CM/CPT coding, Registered Heath Information Technician (RHIT), Registered Health Information Administrator (RHIA) or Certified Coding Specialist (CCS), or RN with above Coding Certifications a plus 
  • Able to work closely with physicians
  • Ability to justify decisions both in writing and verbally 

Job Responsibilities

: 

  • Validate ICD-10-CM coding to ensure proper DRG assignment in order to screen out over billed cases
  • Validate/assign CPT codes to assure proper billing
  • Refer cases with possible utilization and/or quality issues
  • Bring to the attention of the managers and other key staff involved in the review process of any other issues and problems that case review may present
  • Perform on-site reviews within and outside of New York State as assigned
  • Perform varied types of reviews in central office when assigned
  • Adhere to and maintain qualitative and quantitative standards.
  • Coordinate and collaborate on scheduled on-site reviews with other reviewers and the host department in order to ensure the timely completion of the review
  • Record review decisions and justifications for changes requested or issues raised
  • Report daily and weekly output.
  • Inform the personnel involved in the review process of any applicable coding guidelines, conventions and information that will ensure quality in DRG reviews.
  • Maintain professional credentialed status by participating in approved continuing education programs and seminars
  • Perform other duties related to the review process as deemed necessary by the Director.

 




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