The DRG Coding Specialist works under the Coding Manager and oversees compliance with coding standards and regulations. Advises and assists in improvement plans for coding and DRG assignment issues. Validates assignment of codes and provides trending and analysis of coding and DRG issues. Works using the mission, vision, and values of the hospital.

1.Reviews medical records and validates assignment of codes. Recognizes opportunities for revenue enhancement, within coding and compliance guidelines, and makes recommendations accordingly.

2.Effectively and concisely reports all findings and trends to the HIM department, trending of coding changes related to primary or secondary codes, procedures, etc. and the effect of these changes on reimbursement.

3.Proposes and assists in planning and executing appropriate in-service education to coding staff, as related to the findings.

4.Reviews all potential DRG Coding denials from the insurance companies and responds within required time frames and provides documentation in support of findings.

5.Assists the Business Office staff in researching any payment/DRG discrepancies.

6.Assists IP Coding Team Leader with SMART, Soarian Financials EBEW and Huron’s RCW tool as needed.

7.Continues personal education regarding Health Information Management practices to provide guidance and expertise to employees.

8.Works collaboratively and effectively with Clinical Documentation Team.

9.Acts as a resource during the on-boarding and training of new employees.

10.Performs coding audits as needed.

11.Maintains confidentiality and security when dealing with health information.

12.Performs regular coding functions, as needed.

13.Required to report on site as requested.

14.Assumes other duties as assigned by department leadership.

Job Requirements: Associates Degree in Health Information Technology or related field is required and one of the following certifications: CCS/RHIT/RHIA. Approximately 2 years coding and or DRG validation experience in an acute care setting required.