DRG Coder: Job Title: Quality Review and Audit Lead Analyst Job Family Business Operations > Business Operations--Quality Assurance/Audit Band 3
Job Description
DRG Auditor performs an in-depth review of the medical record to evaluate the diagnostic and procedural information in the record and validates accurate coding classification for the DRG assignment for reimbursement of services rendered.
RESPONSIBILITIES:
Reviews clinical documentation and validates facility coding for APR and MS DRG assignment.
Demonstrated ability to understand the clinical content of a medical record, including the most complicated records.
Ability to communicate with Medical Directors when clinical validation is required.
Ability to summarize APR and MS DRG disputes in writing and cites official coding guidelines.
Ability to demonstrate knowledge of and utilize auditing skills related to coding quality and compliance.
Maintains and continuously improves knowledge base of coding/DRG/documentation requirements through review and study of resources and through continuing education.
Ability to serves as a resource to facilitate understanding DRG auditing.
Ability to advise supervisory staff of any concerns or complaints expressed by internal and external customers.
Ability to utilize effective communication; courtesy and professionalism in all interactions.
Performs additional unit duties below as appropriate:
• Participate on special projects.
• Perform random or focused review as required.
• Interface with contracting and provider relations as appropriate to meet customer's needs.
REQUIREMENTS:
Bachelor's Degree preferred or equivalent work experience
Certified Coding Certificate - must have experience in DRG coding.
Knowledge of CMS regulations and statutes;
Knowledge of state/regional insurance regulations;
Ability to deal with highly sensitive and confidential information and adhere to data security and HIPAA confidentiality procedures;
Knowledge of Inpatient coding guidelines and practices.
Effective written and verbal communication skills along with a working knowledge of Microsoft Office.
Ability to apply general rules to specific problems to produce answers that make sense.
Must be able to work independently and as a team while maintaining close attention to detail.
Must be highly motivated, have excellent prioritization skills and have the ability to set and reach goals
Certified Coding Specialist (CCS) or Registered Health Information Technician (RHIT) or (RHIA) required.
***This role is WAH/Flex which allows most work to be performed at home. Employees must be fully vaccinated if they choose to come onsite.***
This position is not eligible to be performed in Colorado.
About Cigna
Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you'll enjoy meaningful career experiences that enrich people's lives. What difference will you make?
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.
