Associate Director; HSO Drg Validation

Job Description

Strength Through Diversity

Ground breaking science. Advancing medicine. Healing made personal.


Roles & Responsibilities:


The Associate Director is responsible for overseeing staff, operations and resources within a department or division to ensure optimal result and high employee engagement. The Associate Director ensures that the department is run according to institutional policies and any applicable regulatory requirements.

Role and Responsibilities:

·         Assists the Director of DRG Validation in maintaining DRG productivity and accuracy standards, while meeting DNFB goals.

·         Acts as a subject matter expert for internal and external stakeholders in reference to coding issues, billing practices, and accuracy of assigned ICD-10 codes.

·         Performs DRG/coding validation reviews on medical records, ensuring compliance with AHA coding guidelines and MSHS policies for complete, accurate, and consistent coding.

·         Performs clinical validation reviews on medical records to ensure that clinical indicators support the documented and coded conditions.  Works closely with the VP of Clinical Data Integrity in the performance of these clinical validation reviews.

·         Complete focused coding/DRG audits at the request of the Director of DRG Validation and/or VP of Clinical Data Integrity.  Provide summary reports of audit findings to departmental leadership.

·         Integrates medical record coding principles, clinical guidelines and objectivity in performance of DRG Validation reviews and special projects. Draws on advanced ICD-10 coding expertise.

·         Provides Leadership for staff members in the form of monthly staff educational   training, performance feedback, goal setting, and problem resolution; cultivate a culture of innovation and creativity.

·         Provides leadership and guidance to DRGV staff members through individual feedback and problem solving.

·         Resolves PFS issues through interpretation and selection of appropriate ICD-10-CM/PCS, codes and /or other information requested for accurate billing and reimbursement. Possesses knowledge and understanding of medical billing requirements.

·         Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; benchmarking state-of-the-art practices; participating in professional societies

·         Plans, develops, and/or maintains departmental standard operating procedures. Regularly reviews policies and procedures and makes changes, or recommends changes to the Director of DRG Validation as necessary.

·         Works collaboratively with Health Information Management staff to resolve and all coding issues.  

·         Performs other duties as assigned.




Required: CCS certification.

RN or Foreign Medical Graduate required
RHIT, RHIA or equivalent degree or related experience preferred.

5-10 years of related experience, working in acute care hospital.

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