MH
Ensures accurate coding and data quality creating consistency and efficiency in inpatient and/or outpatient services through ongoing performance of ICD-10-CM and/or CPT coding validation and accurate MS DRG APR DRG and/or outpatient APC. Responsibilities: Performs coding quality reviews on inpatient records to validate the ICD-10-CM codes DRG group appropriateness missed secondary diagnoses and procedures and ensures compliance with all DRG mandates and reporting requirements. Ensures validity of data prior submission of bill. Performs retrospective coding audits as required. Performs data quality reviews on outpatient encounters to validate the ICD-10-CM CPT and HPCS Level II codes modifier assignments APC group appropriateness missed secondary diagnosis and procedures and ensure compliance with all outpatient coding mandates. Ensures medical necessity criteria is met and local medical review polices are followed. Continuously evaluates the quality of the clinical documentation to spo ...