DRG Specialist

Job Summary: Review clinical documentation within the medical record to ensure that all principal diagnosis, secondary diagnoses, and PCS procedures have been coded accurately and completely as well as certain abstract items in compliance with Official Coding Guidelines, UPMC Coding Guidelines, and OIG regulations on fully coded cases as well as cases on those in training. Assist in training new coding staff. Responsibilities: Review and evaluate focused UPMC electronic health records in Optum, Epic, or Cerner for accurate DRG assignment to ensure that all documented principal and secondary diagnoses, including all complications and co-morbidities, and procedures are accurately coded and sequenced according to coding and compliance guidelines utilizing the Optum coding application. Assists with training of new DRG Specialists and coders as requested. Focus emphasis of educational communications on accurate and thorough documentation necessary to support the coding of diagnoses of the principal diagnosis and any secondary diagnoses in accordance with Official Coding Guideline during an episode of care. Formulate physician queries that present indications of a diagnosis that requires clarity in accordance with Compliant Query Practices an UPMC Coding Guidelines Identify and report issues and trends to the coding management. Prepare and present training when requested on accurate code assignment. Pose initiative thoughts for process improvements within the department. Provide coding staff with education on a case level on any coding issues identified during reviews. Counsel/train coders on problems when necessary, in coordination with the Coding Manager and assist in correcting deficiencies in DRG assignment in the form of an educational email. When requested, investigate code assignment from requesting departments to ensure timely, accurate reimbursement. Function as a resource person to respond to special audits and projects assigned by Management or requested by other departments. 3 years of previous clinical acute care medical/surgical experience to include critical care in conjunction with an expanded knowledge of DRG's. OR completion of Registered Health Information Administration program (RHIA) or Registered Health Information Technician (RHIT) or CCS AND 3 years of experience with the Prospective Payment System and DRG selection; OR specific knowledge as a consultant in Medical Record coding and DRG assignment required. Preferred Experience: 3 years’ experience in an inpatient coding role, or clinical acute care medical/surgical experience to include critical care in conjunction with expanded knowledge of coding and DRG assignment. Knowledge of computer technology, quality assurance activities, DRG methodology background is highly preferred. Ability to communicate with staff, physicians, healthcare providers, and other health care system personnel in a professional and diplomatic manner required. Licensure, Certifications, and Clearances: Certified Coding Specialist (CCS) OR Certified Professional Coder (CPC) OR Certified Registered Nurse Practitioner OR Doctor of Medicine (MD) OR Registered Health Information Administrator OR Registered Health Information Technician (RHIT) OR Registered Nurse (RN) Act 34 *Current licensure either in the state where the facility is located or, if the facility is in a state covered by the multistate Nursing Licensure Compact (NLC) agreement, a multistate license issued by a participating NLC state. Hires and current employees working on an out-of-state NLC license who later change their residency to the state where the facility is also located will have 60 days upon changing their residency to apply for licensure within that state. UPMC is an Equal Opportunity Employer/Disability/Veteran