A diagnosis-related group, most often referred to as a “DRG,” is a system used to classify inpatient stay into specific categories. This is necessary so that hospitals can be reimbursed for their services offered. A DRG auditor is in charge of reviewing a patient’s case and making sure claims were coded correctly according to the diagnosis and treatment, not for the reason that the patient was initially admitted. However, the essential job responsibilities of DRG auditors reach beyond the basics of medical coding and grouping. An expert diagnosis-related group auditor has the following skills.
It’s no surprise that DRG auditors need to be medical terminology experts. However, that skill is not enough for them to advance professionally. They must be able to clearly and effectively communicate with health care professionals about contract specifications and Medicare or Medicaid account concerns. Nurses, physicians and clinical directors are busy and often prefer concise conversations. This position is probably not the best fit for someone who is longwinded or who lacks confidence when bringing up concerns.
It’s not uncommon for DRG auditors to come across inpatient charts that are full of inconsistencies or discrepancies. Professionals don’t rush through the cases to get them done as quickly as possible. They take the time needed to ask questions, pay attention to the details and make sure the correct classification is applied. An auditor may get through only two cases per hour when taking the time needed to problem solve and review the facts.
Ability To Be a Team Player
DRG auditors work side-by-side with medical professionals every day. They must be able to address work-related issues, have strong customer service skills and be able to build relationships with a variety of different personality types.
If you possess these job skills and a love of all things medical, then a DRG auditing position may be a great fit for you.