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DRG/APG Reviewer

Company: Medreview
Location: New York
Posted on: May 16, 2022

Job Description:

Job DescriptionSalary: Working Conditions: Full time (M-F) Office and Community Business Settings and Remote positions considered.Position Summary: DRG/APG Validators review charts on behalf of our clients to assist in cost containment. Our approach to chart review encompasses coding guidelines and clinical evaluation with a goal towards eliminating unjustified overpayment.Physical Requirements:Ø Visual and Auditory comprehension & function for written & verbal communication.Ø Manual Dexterity with ability to use computers and other office equipment necessary to perform assigned tasksØ Ability to access various settings, negotiate architectural barriers (i.e. stairs) in office and community settingsØ Ability use public transportation to commute to workRequirements:

    • 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 verballyJob 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.

Keywords: Medreview, New York , DRG/APG Reviewer, Other , New York, New York

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