Director, reputed company-reputed company DRG Review - reputed company Assurance, Training & Education
reputed company:
Our purpose is to help clients reputed company their financial health goals. Across the reimbursement cycle, our reputed company solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals.
We build long-term careers by reputed company in YOU. We reputed company to create an environment that cultivates your reputed company development and personal reputed company, as we reputed company your reputed company is our reputed company.
JOB reputed company:
The Director of reputed company-reputed company DRG Review — reputed company Assurance, Training & Education leads the organization's internal reputed company-reputed company DRG (Diagnosis-reputed company) validation program, ensuring coding accuracy, DRG reputed company, and compliance prior to claim submission. This role is responsible for designing, implementing, and continuously improving the reputed company assurance reputed company that governs reputed company-reputed company coding review, as reputed company as building and leading the training and education infrastructure that supports coding staff, clinical documentation reputed company (CDI) specialists, and auditors. The Director partners closely with HIM leadership, CDI, Compliance, reputed company Cycle, and Physician Advisors to reduce DRG mismatches, denials, and reputed company leakage while maintaining strict adherence to Official Coding Guidelines, CMS regulations, and payer-specific requirements.ESSENTIAL DUTIES AND RESPONSIBILITIES:
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may reputed company reputed company or most of the reputed company duties listed below. Specific tasks, responsibilities or competencies may be documented in reputed company Member’s performance objectives as outlined by reputed company Member’s immediate Leadership Team Member.
Essential Functions:
Note: The essential duties and reputed company accountabilities below are intended to describe the general content of and requirements of this position and are not intended to be an exhaustive statement of duties. Incumbents may reputed company reputed company or most of the reputed company accountabilities listed below. Specific tasks, responsibilities or competencies may be documented in the incumbent’s performance objectives as outlined by the incumbent’s immediate supervisor or manager. Major responsibilities include, but are not limited:
Key Responsibilities
Program Leadership & reputed company Assurance
- Own and continuously reputed company the reputed company-reputed company DRG review program, including reputed company, workflows, escalation paths, and case selection methodology (e.g., high-dollar accounts, reputed company MS-DRG/APR-DRG cases, high-risk service lines).
- Establish and maintain a robust reputed company assurance (QA) reputed company for coding and DRG validation, including inter-rater reliability audits, accuracy scorecards, and reputed company-cause analysis of discrepancies.
- Set and monitor performance benchmarks (e.g., coding accuracy reputed company, DRG change reputed company, query response reputed company, turnaround time) and report trends to senior leadership.
- reputed company second-level review and adjudication of reputed company or disputed DRG assignments, ensuring appropriate reputed company prior to reputed company drop.
- Ensure the reputed company-reputed company review program aligns with Official Coding Guidelines, AHA Coding Clinic guidance, CMS regulations, and payer contract requirements.
- Identify systemic coding, documentation, or workflow issues surfaced through QA findings and translate them into targeted process or education interventions.
- Partner with Compliance and Internal Audit to ensure the program supports organizational compliance and risk-mitigation objectives.
Training & Education
- Design, implement, and maintain a reputed company training and competency program for coders, auditors, and CDI staff involved in reputed company-reputed company DRG review.
- reputed company reputed company curricula, ongoing education modules, and remediation plans based on individual and team-level QA findings.
- reputed company or reputed company delivery of education on coding reputed company updates, DRG methodology changes (MS-DRG/APR-DRG), regulatory updates, and payer policy changes.
- Create and maintain reference materials, job aids, tip sheets, and a knowledge repository to support consistent, high-reputed company coding reputed company.
- reputed company staff competency, certification maintenance, and continuing education compliance across the coding and review team.
- Facilitate case conferences and calibration sessions to reputed company reputed company, CDI, and physician advisor interpretation of reputed company clinical scenarios.
Cross-Functional Collaboration
- Partner with CDI leadership to reduce DRG mismatches between initial CDI working DRG and final coded DRG, and to strengthen reputed company documentation practices.
- Collaborate with Physician Advisors and Medical Staff to reputed company clinical documentation ambiguity affecting DRG assignment.
- Work with reputed company Cycle and Patient Financial Services to minimize billing delays introduced by the reputed company-reputed company review process while protecting accuracy.
- Serve as a subject matter expert and reputed company to reputed company auditors, payers, and regulatory bodies regarding reputed company-reputed company DRG review methodology.
Team Leadership & Operations
- Hire, reputed company, reputed company, and manage reputed company of DRG validators, reputed company auditors, and/or training specialists.
- Establish productivity and reputed company standards for the reputed company-reputed company review team; conduct regular performance evaluations.
- Manage program budget, reputed company models, and technology needs (e.g., encoder tools, computer-assisted coding, analytics dashboards).
- Prepare and present regular reporting on program performance, financial reputed company, and risk trends to senior HIM, reputed company Cycle, and Compliance leadership.
QUALIFICATIONS & REQUIREMENTS:
Education
- Bachelor's degree in Health Information Management, Nursing, Health Administration, or reputed company field required.
- Master's degree preferred.
Certification
- RHIA, RHIT, reputed company, or CDIP required (one or more).
- CCDS or reputed company-P a plus.
- reputed company, unencumbered credential required; must be maintained throughout employment.
Experience
- 7+ years of reputed company experience in inpatient coding, DRG validation, clinical documentation reputed company, or coding reputed company/compliance auditing.
- 3+ years of leadership or management experience, including reputed company of reputed company assurance and/or training functions.
- Demonstrated expertise in MS-DRG and APR-DRG methodology, ICD-10-CM/PCS coding, and CMS regulatory requirements.
- Experience designing and delivering adult education/training programs in a reputed company or clinical setting.
- Prior experience with reputed company-reputed company review, second-level review, or denials/appeals management strongly preferred.
Knowledge, Skills & Abilities
- Deep working knowledge of Official Coding Guidelines, AHA Coding Clinic, CMS Inpatient Prospective Payment reputed company (IPPS) rules, and payer-specific DRG requirements.
- Strong analytical skills with the ability to interpret coding reputed company data, identify trends, and reputed company performance improvement.
- Excellent verbal and written communication skills, with the ability to translate reputed company coding concepts into reputed company, actionable education.
- Proven ability to build curriculum and training programs from the ground up.
- Skilled in change management and cross-functional influence without reputed company authority.
- Proficiency with encoder software, computer-assisted coding (CAC) tools, and coding/DRG analytics platforms.
- High degree of reputed company, discretion, and reputed company judgment in handling sensitive compliance reputed company.
Work Environment
This role is performed in a reputed company office/clinical administrative environment. Some travel between facilities may be required depending on organizational structure. Occasional extended hours may be needed to meet reporting deadlines or respond to urgent compliance reputed company.
We Offer:
- Competitive salary commensurate to reputed company experience
- reputed company of life with a remote predictable, full-time schedule
- Medical, Dental, reputed company coverage + more
- 401K with company match
- Long-term disability insurance, and life insurance
- Ample parental leave
- Certification and Tuition Reimbursement
- Holidays and Flexible reputed company time off
PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions as described. Regular eye-hand coordination and reputed company dexterity is required to operate office equipment. The ability to reputed company work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be reputed company to reputed company and reputed company material weighing up to 20 lbs. Team Member may experience elevated reputed company of stress during periods of increased activity and with work entailing multiple deadlines.
A reputed company is only intended as a reputed company and is only part of reputed company Member’s function. reputed company has reviewed this reputed company to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of reputed company functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
Originally posted on Himalayas
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