CDI / DRG

Work Setup/Shift: WFO / Night shift

Start Date: ASAP

Qualifications:

• Bachelors Degree in Nursing (BSN) or equivalent healthcare-related degree.
• Must have a Medical Coding License
• 6 months to 1 year in a US Healthcare account
• Knowledge of anatomy and pathophysiology disease process and management
• Coding knowledge (ICD-10-CM & PCS Clinical codes and compliance DRGs with MCCs CCs SOI ROM APR-DRG and MSDRG required)
• Experience with English grammar/written skills and proper query creation
• Must be amenable to report in Ortigas Pasig City

Responsibilities:

1. Clinical Documentation Review & Improvement:

• Review patient medical records including progress notes laboratory results and physician documentation.
• Work closely with healthcare providers to ensure that clinical documentation is accurate complete and gaps in documentation and query physicians to clarify diagnoses and procedures for accurate coding.
  
• Ensure that the documentation supports the correct DRG (Diagnosis-Related Group) assignment and that it aligns with U.S. coding standards and guidelines.

2. DRG Assignment & Compliance:

• Assign DRGs based on the clinical documentation provided and verify that DRG codes are correct for reimbursement purposes.
• Monitor DRG trends and ensure that any discrepancies or issues are flagged and resolved in a timely manner.
  
• Collaborate with coding teams to ensure that medical coding aligns with clinical documentation and DRG assignments.
• Maintain a thorough understanding of DRG-based reimbursement systems and U.S. healthcare regulations (CMS ICD-10-CM/PCS etc.).