Diagnosis Related Group Coordinator

Description

Performs concurrent review of Medicare inpatients in accordance with Diagnosis Related Group Plan. Assesses the financial status of and monitors the organization's potential financial risk for Medicare patients on a concurrent basis. Reviews records of Medicare inpatients to ensure the accurate selection of the principal diagnosis and procedure and any complicating or preexisting conditions in accordance with Medicare definitions. Identifies cases that may qualify for an outlier status and assembles data for an appeal to the Medicare program. Reviews facility and physician case-mix financial data to identify trends and problem areas. Under FLSA, incumbents in this position are nonexempt.