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Credentialing required in one of the following areas Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS)CIRCC, RCCB, CPC, COC, CIC, CCS, or CCS-P certification.
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Education and Certification Requirements:High School Diploma or Equivalent (Required) and Certified Professional Coder (CPC) or Certified Risk Adjustment Coder (CRC) by AAPC. For Hospital Billing, Certified Coding Specialist (CCS), Certified Coding Associate (CCA) or Certified Professional Coder (CPC.
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Certifications in one or more of the following is preferred: a) American Academy of Professional Coders (AAPC) Certifications: Certified Professional Coder (CPC), Certified Outpatient Coding (COC), Certified Inpatient Coder (CIC), and/or Certified Professional Medical Auditor (CPMA.
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Coding credential required from AHIMA/AAPC (RHIA, RHIT, CCS and/or CPC, or CIC) Coding credential required from AHIMA/AAPC (RHIA, RHIT, CCS and/or CPC, or CIC) Review pre-bill cases simultaneously with a physician during each work shift excluding breaks and meetings to analyze and validate diagnosis and procedure codes for inpatient services via coding compliance and clinical knowledge to support accurate DRG assignment.
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QUALIFICATIONS: Certified coder with CCA, CCS-P from AHIMA OR CPC from AAPC in active status. QUALIFICATIONS: Certified coder with CCA, CCS-P from AHIMA OR CPC from AAPC in active status.
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As a valued member of the DRG Review Team, the DRG Integrity Specialist performs a secondary level review of medical records and code assignment using knowledge of Accuity technology and client systems with a physician in accordance with federal coding regulations and guidelines as well as client specific coding guidelines to ensure accurate DRG assignment.
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Knowledge of legal, regulatory, and policy compliance issues related to medical coding and documentation. Experience and knowledge in DRG reimbursement (i.e., MS-DRG, APR-DRG) Advanced knowledge of medical coding, electronic medical record systems, coding systems.
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Current certification as a Certified Coding Specialist (CCS) or Certified Coding Specialist-Physician-based (CCS-P) or Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) by the American Health Information Management Association (AHIMA), or current certification as a Certified Professional Coder (CPC) or a Certified Outpatient Coder (COC) by the American Academy of Professional Coders (AAPC) (formerly CPC-H certification.
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Knowledge of current and developing issues and trends in medical coding diagnosis and procedure code assignment. Researches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, and client denials.
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Licensure: AHIMA or AAPC approved credential(s)- RHIT, RHIA, CCS, CPC, CCA or equivalent. Licensure: AHIMA or AAPC approved credential(s)- RHIT, RHIA, CCS, CPC, CCA or equivalent. Codes, analyzes, and abstracts all scanned or imaged inpatient electronic medical records according to established classification system and enters the abstracted information into the hospital financial system via a CRT. Identifies documents of poor quality.
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Possess either the AAPC (CPC) or AHIMA (CCS-P). Knowledge and experience in third party reimbursement, internal audits, budgeting, financial analysis, and management information systems as well as medical billing and coding.
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Professional coder certification with credentialing from AHIMA and/or AAPC (ROCC, CPC, COC, CPC-P, CCS) to be maintained annually. Adhere to the ethical standards of coding as established by AAPC and/or AHIMA.
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Preferred Skills, Capabilities and Experiences:· American Academy of Professional Coders (AAPC) CPC, CEMC or American Health Information Management Association (AHIMA): RHIA, RHIT, CCS, CCS-P coding certification preferred.
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Position Title: DRG Integrity Specialist. Associates Degree in Health Information Management or similar preferred. Department: DRG Integrity. Attends in-house training sessions to receive updated coding information and changes in coding and/or regulations.
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Certified Coding Specialist - AHIMA (CCS) or Certified Professional Coder - AAPC (CPC) upon hire. Certified Coding Specialist - AHIMA (CCS) or Certified Professional Coder - AAPC (CPC) upon hire.
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