DRG Validator
Newburgh-NY-12550-United States
Pay range: $85,000 - $95,000
Responsible for reviewing inpatient medical records to ensure the accuracy of assigned Diagnosis Related Groups (MS-DRG and APR-DRG) payment systems by validating the coding of diagnoses and procedures, ensuring proper documentation supports the assigned codes and validating the correct reimbursement amount for the patient's hospital stay. This role requires a deep understanding of medical terminology, ICD-10 CM/PCS coding, and coding guidelines to identify and correct any coding/documentation discrepancies.
Education/Training: High School graduate or equivalent required.Associate’s degree preferred in related field. Bachelor’s Degree in Nursing a plus. Ability to read, write and communicate in English. Strong knowledge of medical terminology and anatomy/physiology.
Experience: Minimum ofthree (3) years current DRG validation experience. Denials/Appeals experience. Proficient in ICD-10 CM/PCS coding. Knowledgeable of MS-DRGs, APR-DRGs, quality metrics, and official coding guidelines. Knowledgeable in legal aspects of health information management. Experience in statistical data capture, analysis and reporting. Basic MS Office skills required. Familiarity with Epic and 3M 360 desired. Excellent oral and written communication skills.
Licensure, Registration or Certification: Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), and/or Registered Health Information Administrator (RHIA) required. At least one certification required. Registered Nurse a plus.
Montefiore St. Luke's Cornwall (MSLC) is a not-for-profit hospital dedicated to serving the health care needs of those in the Hudson Valley. In January 2018, St. Luke's Cornwall Hospital officially partnered with the Montefiore Health System, making MSLC part of the leading organization in the country for population health management. With dedicated staff, modern facilities and state-of-the-art treatment, Montefiore St. Luke's Cornwall is committed to meeting the needs of the community and continuing to aspire to excellence.
We are proud to be on Becker's Hospital Review as one of the 150 Great Places to Work in Healthcare, as well as being a Certified Great Place to Work.
Visit https://www.greatplacetowork.com/certified-company/1379468 to learn what makes MSLC an exceptional place to work.
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