DRG Validation Auditor

Penstock is an Equal Opportunity Employer.Role and ResponsibilitiesThe DRG Validation Auditor is a valued member of the Penstock Audit team, responsible for reviewing inpatient claims and ensuring that the DRG paid is fair and accurate, based on the documentation in the medical record and the application of ICD-10-CM and ICD-10-PCS coding conventions, instructions, guidelines, policies, and Coding Clinic advice. The DRG Validation Auditor upholds the standards of honesty, excellence, and innovation that are central to the Penstock mission.Conducts thorough, thoughtful reviews of healthcare claims and medical records to identify discrepancies between the physician documentation, the clinical picture depicted in the record, the codes billed, and the resulting DRGAppropriately uses industry-recognized references to support review findings, including the ICD-10-CM and ICD-10-PCS Official Guidelines for Coding and Reporting, AHIMA Standards of Ethical Coding, AHIMA Practice Briefs related to compliant querying, and AHA Coding ClinicsWrites complete, clear, and accurate rationale to support audit determinations, citing specific information from the record, and referencing appropriate guidelines, policies, regulations, and/or Coding adviceKeeps abreast of coding, clinical, regulatory, and other industry changes that impact Penstock auditing and/or that suggest new audit opportunitiesMaintains focus on the identification and development of new audit conceptsContinuously considers the systems and processes involved with healthcare reimbursement (both internal and external) and communicates ideas for improvement through appropriate channelsParticipates in focused training to learn new auditing skills across a myriad of clinical and coding scenariosCommunicates kindly, professionally, and effectively with all customers, both internal and external, and refers issues to management as appropriateContinuously strives to find new avenues for fulfilling the Penstock mission of reclaiming greater integrity between payors and providersServes as a Payment Integrity subject matter expert for Penstock team members and for the Goodroot organization as a wholeMeets or exceeds Penstock's performance and quality standards.Senior Auditor positions provide support for Team Lead as required.Qualifications and Education RequirementsMinimum of an associate degreeCurrent AHIMA coding credential(s): RHIT, RHIA, or CCSCurrent Clinical Validation credential(s): CDIP, CCDS, or CDEI3 or more years of ICD-10 inpatient coding experience3 or more years of clinical experience in a healthcare facility setting3 or more years of auditing experience (or demonstrated equivalent)Comprehensive understanding of ICD-10-CM Inpatient Coding Guidelines, AHA Coding Clinic, and DRG grouping mechanicsStrong current clinical knowledgebaseFamiliarity with Clinical Documentation Integrity practicesAwareness of and adherence to HIPAA, and all laws regarding the safeguarding of PHI/PIIAbility to conduct independent research using credible sourcesDemonstrated working knowledge of Microsoft Word, Excel, and PowerPointAbility to apply critical thinking skills to record reviewsAbility to work independently, manage workload, and adapt to shifting prioritiesWillingness to adapt and learn new auditing skills across a myriad of coding and clinical scenariosExcellent communication skills, both oral and writtenComfortable working in an ever-changing fast paced environmentAble to work Eastern time zone hoursSecure and private home office with reliable high-speed internet connectionPreferred SkillsBachelor's degree5+ years of inpatient ICD-10 coding and auditing experience5+ years of relevant auditing (clinical validation and medical necessity) experienceAHIMA/AAPC Coding Certification (RHIA, RHIT, CCS, CPC, CPC-H), AHIMA/ACDIS Clinical Documentation Certification (CDIP, CCDS), or Clinical Documentation Integrity experience#J-18808-Ljbffr