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CDI / DRG
2 weeks ago
Work Setup/Shift: WFO / Night shift
Start Date: ASAP
Qualifications:
- Bachelors Degree in Nursing (BSN) or equivalent healthcare-related degree.
- Must have a Medical Coding License
- 6 months to 1 year in a US Healthcare account
- Knowledge of anatomy and pathophysiology, disease process and management
- Coding knowledge (ICD-10-CM & PCS, Clinical codes and compliance, DRGs with MCCs, CCs, SOI, ROM, APR-DRG and MSDRG required)
- Experience with English grammar/written skills and proper query creation
- Must be amenable to report in Ortigas, Pasig City
Responsibilities:
1. Clinical Documentation Review & Improvement:
- Review patient medical records, including progress notes, laboratory results, and physician documentation.
- Work closely with healthcare providers to ensure that clinical documentation is accurate, complete, and up-to-date.Identify gaps in documentation and query physicians to clarify diagnoses and procedures for accurate coding.
- Ensure that the documentation supports the correct DRG (Diagnosis-Related Group) assignment and that it aligns with U.S. coding standards and guidelines.
2. DRG Assignment & Compliance:
- Assign DRGs based on the clinical documentation provided and verify that DRG codes are correct for reimbursement purposes.
- Monitor DRG trends and ensure that any discrepancies or issues are flagged and resolved in a timely manner.
- Collaborate with coding teams to ensure that medical coding aligns with clinical documentation and DRG assignments.
- Maintain a thorough understanding of DRG-based reimbursement systems and U.S. healthcare regulations (CMS, ICD-10-CM/PCS, etc.).