DRG收入完整性主管
Supervisor, DRG Revenue Integrity
关于我们：
我们的目标是帮助客户实现其财务健康目标。在报销流程中，我们的可扩展解决方案和临床专业知识帮助解决程序性需求。通过领先的科技赋能我们的团队，使分析能够指导我们的解决方案，并确保我们达成目标。
我们通过投资于你来打造长期职业发展。我们致力于创造一个促进你职业发展和个人成长的环境，因为我们相信你的成功就是我们的成功。
职位概述：
DRG完整性审核/审计主管负责监督复杂、并发和回顾性编码审核的执行、质量和交付。该职位确保符合AHA、CMS、AMA、AHIMA、AAPC、编码诊所、CPT助理和官方编码指南的要求，同时监督审核员团队。审核主管提供二级审核、客户交付物、编码教育和质量保证，以支持客户和组织的目标。
需持有AHIMA认证的CCS
这是一个远程职位
主要职责和责任：
注意：以下主要职责和责任旨在描述该职位的一般职责和责任，并非对该职位职责的详尽陈述。该职位可能执行以下大部分或全部主要职责。具体任务、责任或能力可能根据直接上级领导团队规定的员工绩效目标进行记录。
团队监督与领导
- 与领导层协调团队和客户的交付安排。
- 将新客户分配给审核员，发送每周任务，并确保访问客户信息。
- 及时向审核员提供编码指南和部门流程的更新/变更。
- 作为所负责审核的审核员的领域专家（SME）。
- 对新老审核员进行培训，以保持团队的能力。
- 提供对审核员绩效的见解；包括生产率、质量和发现机会的比率。
- 对部门至少25%的工作成果进行质量保证检查，确保最低95%的准确率。
- 在团队内部促进团队合作、知识共享和尊重的沟通。
- 生产率与质量标准
- 满足每项审核的记录类型设定的生产率标准。
- 当客户工作可用时，保持计费有效工时达到或超过80%。
- 监控并报告
查看英文原文
About Us:
Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals.
We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.
JOB SUMMARY:
The Supervisor, DRG Integrity Reviews/Audits, is responsible for overseeing the execution, quality, and delivery of complex, concurrent, and retrospective coding audits. This role ensures compliance with AHA, CMS, AMA, AHIMA, AAPC, Coding Clinic, CPT Assistant, and official coding guidelines, while supervising a team of auditors. The Supervisor provides second-level review, client deliverables, coding education, and quality assurance to support both client and organizational goals.
CCS through AHIMA is required
This is a remote position
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.
Team Supervision & Leadership
- Coordinate scheduling of team and client deliverables with leadership.
- Assign new clients to auditors, send weekly assignments, and ensure access to client information.
- Provide auditors with timely updates/changes to coding guidelines and department processes.
- Serve as a Subject Matter Expert (SME) for auditors across assigned audits.
- Conduct training for new and existing auditors to maintain team competency.
- Provide insight to auditor performance; productivity, quality and opportunity find rates
- Conduct QA of at least 25% of departmental work products, ensuring a minimum 95% accuracy threshold.
- Promote teamwork, knowledge sharing, and respectful communication across the team.
Productivity & Quality Standards
- Meet productivity standards set by record type for each audit.
- Maintain billable productive hours at or above 80% when client work is available.
- Monitor and report time, work products, and schedules in an accurate and timely manner.
- Recommend process improvements to streamline workflows and enhance efficiency.
Education & Professional Development
- Participate in development and delivery of coding education for clients.
- Stay current on coding, reimbursement, and compliance issues through continuing education.
- Maintain active professional credentials as required.
Audit & Compliance
- Perform complex concurrent and/or retrospective analysis of medical record documentation to validate coded data.
- Ensure compliance with legal and procedural policies, official coding guidelines, and AHIMA Standards of Ethical Coding.
- Conduct independent QA on assigned Reviews/Audits results with a minimum accuracy expectation of 95%.
- Protect the privacy and confidentiality of patient and client health information at all times.
Reporting & Client Deliverables
- Analyze Reviews/Audits findings and identify root causes of coding errors.
- Prepare detailed summary reports of findings, citing official references.
- Ensure deliverables are accurate, timely, and aligned with client expectations.
- Act as client liaison/expert in organizational policies, maintaining an audit playbook for each assigned client.
- Provide back-up leadership support for client interactions when needed.
Special Projects
- Lead or participate in special projects requiring coding and auditing expertise across the organization.
- Support leadership in implementing new initiatives and process improvements.
Qualifications and Requirements:
- CCS credential (through AHIMA) required.
- Minimum 5 years’ experience in DRG auditing, coding, or HIM consulting.
- Previous supervisory or lead auditor experience strongly preferred.
- Strong knowledge of ICD-10-CM/PCS, CPT, MS-DRG, APR-DRG, and reimbursement methodologies.
- Excellent analytical, communication, and report-writing skills.
- Ability to manage multiple projects and priorities in a fast-paced consulting environment.
Performance Expectations
- Audit QA accuracy threshold: 95% minimum.
- Billable productivity threshold: 50% minimum (when client work is available).
- Demonstrated ability to apply coding principles consistently to evolving scenarios.
This is a remote position
PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
Originally posted on Himalayas