Department: Health Services

Position Summary:
Creates reports in Access and Excel databases to ensure that DRGs reviewed result in measurable savings. This involves decision making based upon the report resulting in ID of DRGs to add/delete from reviews, then implementing those changes into the work process. Work with Hiring Manager and supervisors at various facilities to come to agreements concerning expectations and extensions for on-site visits and DRG validation changes. Tracks volume and status of DRG cases. Sends questions to Coding Clinic that clarifies coding issues as it relates to a case. Reviews the Medicare adjusted code listing against certain DRG claims in Amysis to ensure MVP recoups additional monies. Completes other duties regarding UM/Health Services functions as assigned by the UM Supervisor or Manager.

Requirements:

• RN preferred. BS in health management or administration is preferred. RHIT, CCS, CPC CPC-H preferred. 3+ years strong Coding experience with a minimum of 1 year UM experience preferred.
• Proven success with interacting with providers on delicate matters of medical necessity and service appropriateness. Demonstrated problem-solving skills with excellent verbal and written communication abilities.
• Familiarity with Diagnoses and Procedural Coding Practices required. Independent thought process; oriented toward probing/case coordination. Strong PC skills.
• Able to manage multiple tasks in a fast-paced environment. Excellent verbal and written communication skills.

Status: Full Time

Type: Exempt

In order to be considered for this position, please apply online. Questions? Please Contact: