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Cleveland Clinic



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DRG Assurance Coordinator - Main Campus Job


Reference Title
HR Use Only: DRG Assurance Coordinator - Main Campus
Hospital: Cleveland Clinic Main Campus & Family Health Centers
Department: HDS CODING
Job Code: U23000
Pay Grade: 12
Schedule: Full Time
Shift: Days
Hours: 7-3:30
Job Details:

Summary: The DRG Assurance Coordinator (DAC) insures hospital case-mix index and severity profiles are accurate by performing DRG Assurance program activities. The coordinator insures appropriate MS-DRG (Diagnosis Related Group), APR-DRG (All Patient Refined Diagnosis Related Group), SOI (Severity of Illness) and ROM (Risk of Mortality) assignments. As well as any other inpatient grouping system employed and used by fiscal intermediaries, regulatory agencies, accrediting bodies, etc.

Job Responsibilities: Works collaboratively with Medial, Nursing, Case Management and ancillary staffs to improve the quality of chart documentation and to accurately reflect a patient’s severity of illness. Communicates verbally or written via DRG Assurance prompter with physician to obtain/offer more specific principal diagnosis, secondary diagnoses, or procedures when it affects DRG or SOI/ROM score. Solicits clarification of existing documentation. Responds and/or communicates appropriately and timely to medical and other staff. Provides physician education and assistance when needed. Follows coding, CMS, hospital and compliance guidelines at all times. Meets operational standards of the DRG Assurance program. Assists co-workers and management as workload requires. Consistently maintains quality and productivity standards. Performs initial case review and follow up review appropriately and within the established time frames. Follows open physician queries and obtains response with minimal intervention prior to discharge, or final coding as appropriate. Completes the DRG update screen for hospital LOS initiatives on a daily basis. Completes documentation on DRG worksheet according to established standard practices. Insures appropriate and accurate DRG, APR-DRG, SOI and ROM assignment. Works collaboratively with HDS Coding staff to prepare chart for final coding and billing. Contributes and participates in team education efforts and activities. Communicates cooperatively on a daily basis with Coding staff to promote team approach to DRG assignment. Assists at all times in meeting departmental target time frames and key indicators. Refers problematic cases to DRG Assurance Supervisor. Other duties and responsibilities. Accurately completes other duties by established deadlines. Maintains flexibility to meet organizational demands for new skills and knowledge. Other duties as assigned.

Education: Associate's Degree in health related field.

Experience: Thorough and up-to-date clinical skills. Experience in working directly with physicians. Utilization Review, Case Management, and/or Coding and DRG assignment experience strongly preferred. Excellent written and verbal communication skills required. Ability to write inquiries to physicians. Ability to effectively communicate with physicians to relay and obtain information as well as respond to questions. Assertive personality and team player, dependable, aptitude for accuracy, detail and organization skills, PC and/or encoder experience. Must be detail-oriented. Will need to work independently with minimal direct supervision and be able to resolve problems independently.

Licensure/Certification/Registration: Current license as a Registered Nurse, or Licensed Practical Nurse in the State of Ohio with one year of review experience or coding experience preferred. RHIA/RHIT/CCS/CCA with utilization review or concurrent DRG assignment experience preferred. Physical Requirements: Physical demands require standing, walking, sitting, lifting, carrying up to 25 lbs. Close, distant, and color vision is required. Requires manual dexterity to grasp and handle records and to operate a PC computer in the course of work. The work environment is at a moderate noise level (business office with phones, copiers, computers, and printers).

Category: Managerial/Professional/Physician

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