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DRG Validation Educator and Trainer
DRG Validation Educator and TrainerMedReview • US
DRG Validation Educator and Trainer

DRG Validation Educator and Trainer

MedReview • US
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At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare.

As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews.

Under the direction of the Assistant Director of DRG Quality and Education the DRG Validation Educator and Trainer will be a subject matter expert relating to DRG (inpatient) coding and reporting, be responsible for onboarding new staff members or vendors, conduct educational sessions (1 :

  • 1 or in a group setting), assist with conduct quality assurance audits, as well be assigned to other tasks as needed.

Responsibilities  40% :

  • Onboarding
  • Responsible for training new staff in the scope of DRG Validation and system processes.
  • Audit claims (retrospective and / or live production) during the onboarding timeframe
  • Conduct 1 : 1 feedback sessions to answer any questions or review previously reviewed claims.
  • Lead the “go / no-go” discussions with the DRG operations leadership team.
  • Continue to refine the onboarding program, as needed.
  • Act as a new hire mentor.   30% : Education Content Creation and Delivery
  • Create and deliver ongoing coding education including official coding guideline changes / annual updates and clients’ clinical guideline changes.
  • Trend and analyze audit findings to determine educational needs.
  • Collaborate with physician leaders for development of clinical related content.   20% : Subject Matter Expert and General Tasks
  • Act as a Subject Matter Expert (SME) for all coders within the department.
  • Assist with the development of coding reference tools, policies and procedures for systems and applications.
  • Assist with development and research of coding targets for selection purposes.
  • Demonstrates the ability to participate in ongoing department projects.
  • Ability to prioritize and organize workloads and complete tasks independently.
  • Required attendance of all departmental team meetings and / or training.
  • Work on other duties or tasks, as necessary. 10% : QA Audit Reviews
  • Analyze and audit inpatient claims following the Official Coding and Reporting Guidelines to validate the reported ICD-10-CM / PCS codes to ensure proper DRG assignment for accurate billing.
  • Conduct focused audits or ad-hoc audits, as needed.
  • Assist with regular QA audits of staff and / or vendors, as needed.
  • Performance Expectations
  • Deliver education content as outlined by the Director of DRG Quality and Education
  • Report productivity daily utilizing department productivity report.
  • Meet / exceed productivity expectations as outlined in the department's productivity policy.
  • Complies with organizational policy and procedures.
  • Qualifications
  • Coding Certification required (CCS / CIC)
  • RHIA or RHIT, preferred
  • Requires 5+ years of experience in MS-DRG and APR-DRG coding experience through acute care inpatient coding, auditing, and / or payment integrity DRG Validation.
  • Experience in education and / or training of coding staff preferred.
  • Adherence to the Official Coding and Reporting guidelines, AHA Coding Clinic determinations, and CMS and other regulatory compliance guidelines and mandates.
  • Requires working knowledge of applicable industry-based standards.
  • Proficiency in Outlook, Word, Excel, and other applications.
  • Excellent written and verbal communication skills.
  • Maintain professional credentialed status with approved continuing education programs.
  • Ability to work independently and can multi-task or transition to different tasks easily.

    • Remote Work  Remote Work Requirements :

  • High speed internet (100 Mbps per person recommended) with secured WIFI.
  • A dedicated workspace with minimal interruptions to protect PHI and HIPAA information.
  • Must be able to sit and use a computer keyboard for extended periods of time.

    • Benefits and perks include :

  • Healthcare that fits your needs  - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents. 401(k) with Employer Match  - Join the team and we will invest in your future Generous Paid Time Off  - Accrued PTO starting day one, plus additional days off when you’re not feeling well, to observe holidays.
  • Wellness  - We care about your well-being.
  • From Commuter Benefits to FSAs we’ve got you covered.
  • Learning & Development  - Through continued education / mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional.

    • Salary Range :

  • $95,000- 105,000 / annually.  Powered by JazzHR
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