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CDI DRG Validation
A CDI DRG reviewer job description generally involves reviewing patient records to ensure that the assigned Diagnosis Related Group (DRG) accurately reflects the patient’s clinical status and care, leading to accurate coding and reimbursement. They work with coding, CDI, and provider teams to identify and address documentation gaps that could impact reimbursement.
Here’s a more detailed breakdown:
Key Responsibilities:
- Clinical Chart Review:
Conducting comprehensive secondary reviews of patient records to identify potential opportunities for documentation improvement. - DRG Validation:
Ensuring the accuracy of the assigned DRG by reviewing the medical record and comparing it to coding guidelines. - Query Initiation and Management:
Identifying documentation gaps and communicating them to physicians through queries, following ACDIS guidelines for compliant query writing. - Denial Management:
Reviewing denials related to DRG assignment and working with the CDI team to appeal denials when appropriate. - Collaboration:
Working with coders, CDI specialists, and providers to resolve DRG discrepancies and ensure accurate coding. - Education and Training:
Providing education to CDI team members, coding staff, and providers on documentation guidelines and DRG assignment. - Data Tracking and Analysis:
Tracking DRG validation results, missed opportunities, and query compliance to identify trends and areas for improvement.
Essential Skills and Qualifications:
- Strong Clinical Knowledge:
A solid understanding of medical terminology, anatomy, physiology, and disease processes. - DRG and Coding Knowledge:
Familiarity with coding guidelines, DRG assignment, and documentation requirements. - Excellent Communication Skills:
Ability to communicate effectively with physicians, coders, and other healthcare professionals.
Location: remote,
Type: Direct Hire
Pay: Apply for details
1710