Category: Analytics and Emerging Digital Technologies
Main location: United States, Texas, Dallas
Alternate Location(s): United States, Arizona, Phoenix
United States, California, Los Angeles, San Fransisco
United States, Colorado, Denver
United States, District of Columbia, Washington DC
United States, Georgia, Atlanta
United States, Illinois, Chicago
United States, Maryland, Baltimore
United States, Nevada, Las Vegas
United States, New Jersey, Jersey City
United States, New York, New York City
United States, Ohio, Colombus, Cleaveland, Cincinatti
United States, Pennsylvania, Philadelphia
United States, Texas, Dallas, Austin,Houston
United States, Virginia, Fairfax, Richmond
Position ID: J1123-0551
Employment Type: Full Time
The DRG Validation Auditor is a member of the CGI Healthcare Compliance, DRG Validation Team, with responsibility for reviewing medical records to determine the accuracy of coding and reimbursement for clinical services rendered to beneficiaries of health plans, including Commercial and Government Clients. The DRG Validation Auditor is charged with rendering appropriate, well-supported, and thoroughly-documented decisions which may result in the identification of improper payments (overpayments and underpayments) on paid claims on behalf of the client from various providers of clinical services, including but not limited to acute care, long-term acute care, acute rehabilitation, and skilled nursing facilities, as well as other provider types and care settings. The DRG Validation Auditor is prepared for the role through a detailed, well-defined training process, gaining knowledge and skills in methods for review of the medical record and other provider documentation, application of appropriate coding guidelines, and use of the documentation format tailored to the client’s requirements. Ongoing training and education are provided specific to audit processes, coding and reimbursement changes, and other topics as indicated. The review process may result in changes to the payment for previously-rendered services, and decisions are rendered through a well-defined process which requires the Auditor to incorporate coding experience and knowledge, as well as critical thinking skills in order to assess available information and render a decision. The DRG Validation Auditor reports to a DRG Validation Team Leader, who provides support, feedback, and guidance to the Auditor. Audit performance review and quality assurance are provided through a well-defined review and quality management program.
Your future duties and responsibilities:
• Reviews inpatient medical records to validate, assignment and sequencing of ICD-10 diagnosis and procedure codes, discharge status codes, Hospital Acquired Conditions (HACs), POA assignment, and DRG assignment.
• Provides a detailed rationale for every medical record review resulting in a DRG Review Results letter, including supporting references.
• Follows proper procedure for referral to Clinical Nurse Auditor or Physician Advisor, as applicable.
• Utilizes proper reference material, standards, and guidelines for coding.
• Provides input to the Edit Development team on claims selection criteria.
• Verifies data received from client and work to resolve discrepancies.
• If the contract requires onsite review, interacts with Providers and other personnel in a professional manner.
• Follows CGI policies and processes, completing Red Carpet, timesheets, payroll, travel expense documents, and other corporate requirements in a timely manner.
• Communicates timely with Team Lead regarding illnesses, appointments, vacation requests, changes in work schedule, performance barriers, and computer issues.
• Complies with department standards regarding productivity and audit quality.
• Performs other duties as assigned.
Required qualifications to be successful in this role:
The DRG Validation Auditor possesses current AHIMA credentials (RHIT/RHIA/CCS), with current CCS (certified coding specialist) preferred.
The Auditor demonstrates extensive knowledge of ICD-10-CM/PCS coding and DRG reimbursement, with a minimum of five (5) years of inpatient coding experience.
Previous experience training and mentoring junior-level coders is highly desired.
The DRG Validation Auditor must understand government and commercial provider reimbursement methodologies (MS-DRG and APR-DRG), and possesses strong clinical validation skills, as well as data analytic skills.
A working knowledge of computer functions and applications such as Microsoft Office (Outlook, Word, Excel) and Windows operating systems is required in order to manage applications utilized in the audit process.
The ability to write a well-reasoned review in a narrative style, with accurate spelling, grammar, punctuation, and sentence structure is required for success in the audit position. The auditor must be able to adapt to changing priorities in order to meet Client requirements, and is required to meet department productivity standards and deadlines.
The auditor must be proactive and self-directed, self-sufficient in completing tasks, as well as detail-oriented, with a passion for life-long learning.
The Auditor may be required to travel for additional training and on-site reviews on an as-needed basis.
*CGI is required by law in some jurisdictions to include a reasonable estimate of the compensation range for this role. The determination of this range includes various factors not limited to: skill set level; experience and training; and licensure and certifications. CGI typically does not hire individuals at or near the top of the range for their role. Compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $60,300 -$118,700.
At CGI we call our professionals “members” to reinforce that all who join our team are, as owners, empowered to participate in the challenges and rewards that come from building a world-class company. CGI’s benefits include:
Competitive base salaries
Eligibility to participate in an attractive Share Purchase Plan (SPP) in which the company matches dollar-for-dollar contributions made by eligible employees, up to a maximum, for their job category
401(k) Plan and Profit Participation for eligible members
Generous holidays, vacation, and sick leave plans
Comprehensive insurance plans that include, among other benefits, medical, dental, vision, life, disability, out-of-county emergency coverage in all countries of employment;
Back-up child care, Pet insurance, a Member Assistance Program, a 529 college savings program, a personal financial management tool, lifestyle management programs and more
- Registered Health Info Admin
What you can expect from us:
Insights you can act on
While technology is at the heart of our clients’ digital transformation, we understand that people are at the heart of business success.
When you join CGI, you become a trusted advisor, collaborating with colleagues and clients to bring forward actionable insights that deliver meaningful and sustainable outcomes. We call our employees “members” because they are CGI shareholders and owners and owners who enjoy working and growing together to build a company we are proud of. This has been our Dream since 1976, and it has brought us to where we are today — one of the world’s largest independent providers of IT and business consulting services.
At CGI, we recognize the richness that diversity brings. We strive to create a work culture where all belong and collaborate with clients in building more inclusive communities. As an equal-opportunity employer, we want to empower all our members to succeed and grow. If you require an accommodation at any point during the recruitment process, please let us know. We will be happy to assist.
Ready to become part of our success story? Join CGI — where your ideas and actions make a difference.
Qualified applicants will receive consideration for employment without regard to their race, ethnicity, ancestry, color, sex, religion, creed, age, national origin, citizenship status, disability, pregnancy, medical condition, military and veteran status, marital status, sexual orientation or perceived sexual orientation, gender, gender identity, and gender expression, familial status, political affiliation, genetic information, height, weight, or any other legally protected status or characteristics.
CGI provides reasonable accommodations to qualified individuals with disabilities. If you need an accommodation to apply for a job in the U.S., please email the CGI U.S. Employment Compliance mailbox at USEmploymentCompliance@cgi.com . You will need to reference the Position ID of the position in which you are interested. Your message will be routed to the appropriate recruiter who will assist you. Please note, this email address is only to be used for those individuals who need an accommodation to apply for a job. Emails for any other reason or those that do not include a Position ID will not be returned .
We make it easy to translate military experience and skills! Clickhere (https://cgi-veterans.jobs/) to be directed to our site that is dedicated to veterans and transitioning service members.
All CGI offers of employment in the U.S. are contingent upon the ability to successfully complete a background investigation. Background investigation components can vary dependent upon specific assignment and/or level of US government security clearance held. CGI will consider for employment qualified applicants with arrests and conviction records in accordance with all local regulations and ordinances.
CGI will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with CGI’s legal duty to furnish information.