As the DRG Validation Reviewer, you play an essential role in ensuring the health system is in compliance with Federal and State regulations. You will conduct DRG Validation to ascertain that the diagnostic and procedural information that led to the DRG assignment can be substantiated by the documentation in the Medical Record.
Audits and reviews Medicare and non-Medicare charts to ensure that proper DRG standards are maintained in conformance with Federal and State regulations.
- Reviews attestation statements of all Medicare and non-Medicare charts formulated by the Medical Record Coding Analyst
- Identifies appropriate coding changes necessary to provide the most valid DRG in compliance with Federal and State regulations
- Corrects the face sheet, generating a new attestation statement and dollar value sheet for each record entered on the 3m Grouper, and inserts these forms into the Medical Record
- Applies ICD-9-CM coding rules and regulations to the DRG Validation review process
Interacts with the attending physicians and house staff when there is a discrepancy with information written on the chart or on the attestation statement.
- Makes appropriate corrections, as necessary
- Assists attending physicians and house staff in providing appropriate documentation in the Medical Record to substantiate the DRG assignment
- Bachelor's Degree in Nursing, preferred
- Graduate from an accredited School of Nursing
- Licensed to practice as a Registered Professional Nurse in New York State
- Completion of certified ICD-9-CM coding program, preferred
- Minimum of two (2) years of experience in a clinical setting, required
- Minimum of one (1) year of experience in chart review/hospital reimbursement and regulatory background, required
Transforming care, optimizing patient satisfaction and creating better patient outcomes are just some of the things our talented team members are doing at North Shore-LIJ each and every day. As a culture committed to providing our customers with the highest quality service, we stand behind our core values: Patients first; Caring; Excellence; Innovation; Integrity and Teamwork. It is our commitment and our culture that sets us apart from others and is the cornerstone of everything we do. Join an organization whose team members are valued, cared for and offered continuous opportunities to grow. Click on the link to learn more about us: www.northshorelij.com/goals
Please note: North Shore-LIJ is a smoke-free environment. Smoking and the use of tobacco products is strictly prohibited anywhere on campus, including parking lots and outdoor areas on the premises. Free smoking cessation programs and quit medications are offered to team members who wish to quit through the North Shore-LIJ Center for Tobacco Control.