Position Summary: Located at the Mount Sinai Medical Center, NY. The Clinical Reimbursement Manager is responsible for performing quality reviews on medical records to validate the ICD-9-CM codes, DRG appropriateness, missed secondary diagnoses and procedures, and ensure compliance and accuracy of the MS-DRG and APR DRG. The Clinical Reimbursement Manager will continuously evaluate the quality of clinical documentation and monitor the appropriateness of physician queries with the overall goal of improving physician documentation through physician education and feedback and achieve accurate coding to support the optimal allowable reimbursement. The Clinical Reimbursement Manager works closely with the Coding Compliance Coordinator and Coding Compliance Manager to provide coding staff with feedback to assure coding uniformity, consistency and accuracy with ICD-9-CM and CPT-4 guidelines, UHDDS, sequencing guidelines, Federal and State regulations and the American Hospital Association coding guidelines and its publication Coding Clinic and AMA's publication CPT Assistant. The Clinical Reimbursement Manager works in conjunction with the Director of Health Information Management to develop coding in-services and institutional coding policies to ensure that coding policies complement the official coding rules and guidelines.
Position Requirements: Strong foundation in clinical medicine, ICD-9 CM and CPT-4 Coding. Knowledge of medical terminology. Excellent knowledge of federal and All-Payer DRG reimbursement methodology. Must be detail oriented with good verbal, written, communication, interpersonal and customer friendly skills. Ability to work under pressure with time constraints. Must be able to understand and follow written and verbal instruction.