- UPMC (Pittsburgh, PA)
- UPMC Corporate Revenue Cycle is hiring a DRG Specialist to work on inpatient auditing within our Coding Department. This position will be a work-from-home position ... OIG regulations. **Responsibilities:** + Review and evaluate focused UPMC DRG medical records for accurate DRG assignment...focused UPMC DRG medical records for accurate DRG assignment to ensure that all documented principal and… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …leadership programs and more! **Description** We are seeking an experienced **Inpatient DRG Coding Auditor** to extract data from patient encounters ensuring the ... the accuracy and completeness of diagnosis and procedure coding, DRG assignment, and abstracted data POA, Discharge Disposition. +...+ Reviews discrepancies between the Clinical Documentation Specialist (CDS) DRG and the Coder DRG . + Reviews… more
- Elevance Health (Grand Prairie, TX)
- ** DRG CODING AUDITOR** **_Virtual_** **_: _** _ _ __ _This role enables associates to work virtually full-time, with the exception of required in-person training ... determined to recover, eliminate and prevent unnecessary medical-expense spending. The ** DRG CODING AUDITOR** is responsible for auditing inpatient medical records… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The purpose of DRG validation is to confirm that diagnostic, procedural information, and the discharge status of the beneficiary, as coded and ... 10th Revision (ICD-10-CM and ICD-10-PCS) codes and the Diagnosis Related Groups ( DRG ). The CRM reviews the physician documentation for specificity, completeness and… more
- Banner Health (OH)
- …quality in the Inpatient Facility Coding department. If you have experience with DRG and PCS coding/denials/audits, we want to hear from you. **Requirements:** + **5 ... facility-based medical coding (clearly reflected in your attached resume);** + ** DRG and PCS Coding, Auditing experience;** + **Bachelors degree or equivalent;**… more
- Kaleida Health (Buffalo, NY)
- **Director Clinical and DRG Denials** **Location:** Larkin Bldg @ Exchange Street Location of Job: US:NY:Buffalo Work Type: Full-Time **Shift:** Shift 1 Job ... Description **Summary:** The Director, Clinical & DRG Denials provides clinical leadership and administrative guidance to the Clinical Revenue Cycle department.… more
- Humana (Montgomery, AL)
- …Management organization, including offshore and vendor partners, with a focus on DRG audits. You will also drive process improvement initiatives and develop ... Management organization, including offshore and vendor partners, with a focus on DRG audits. You will also drive process improvement initiatives and develop… more
- CVS Health (Hartford, CT)
- …Commercial and Medicare environment. In addition, be a subject matter expert in DRG reviews and ICD-10 code selection. The Primary Responsibilities of this Medical ... / CPT, Clinical Policy, Reimbursement and Health Care Systems. * Experience with DRG reviews. * Strong communication skills both written and verbal. **Education** *… more
- Hartford HealthCare (Farmington, CT)
- …2 is responsible for reviewing, analyzing, and appealing denials related to DRG (Diagnostic Related Group) validation denials. This role involves validating the ... address payer concerns. Key responsibilities include timely investigation of DRG downgrades, submitting appeals, coordinating follow-up actions, and ensuring… more
- St. Luke's University Health Network (Allentown, PA)
- …data and coding of all diagnosis and procedure codes to assure properly assigned MS- DRG for the purposes of appealing proposed MS- DRG and coding changes by ... record reviews for diagnosis and procedure code assignment and MS- DRG accuracy for inpatient encounters and CPT assignment for...inpatient encounters and CPT assignment for OP encounters. Analyze DRG or CPT denial letters and draft appeal letters,… more
- Humana (Santa Fe, NM)
- …expertise in Medicaid reimbursement methodologies rooted in complex grouping concepts (EAPG, APR- DRG , MS- DRG , etc). This role is within the Integrated Network ... for hospitals and facilities + Developing expertise in complex groupers (EAPG, APR- DRG , MS- DRG , etc) utilized in Medicaid reimbursement + Reviewing Medicaid… more
- Hartford HealthCare (Farmington, CT)
- …alpha numeric diagnosis/procedure codes and Medicare Severity Diagnosis Related Groups (MS- DRG ). Data is classified for internal and external statistical reporting, ... and/or encoder, coding manuals and other reference material. 3. Reviews DRG assigned to each record. Enters coded/abstracted information into software, analyzes… more
- Hartford HealthCare (Farmington, CT)
- …alpha numeric diagnosis/procedure codes and Medicare Severity Diagnosis Related Groups (MS- DRG ). Data is classified for internal and external statistical reporting, ... and/or encoder, coding manuals and other reference material. 3. Reviews DRG assigned to each record. Enters coded/abstracted information into software, analyzes… more
- Trinity Health (Silver Spring, MD)
- …and secondary procedures. Assigns appropriate Medicare Severity Diagnosis Related Groups (MS- DRG ), All Patient Refined DRGs (APR), Present on Admission (POA), as ... of Diseases, Clinical Modification (ICD-CM) diagnosis and procedure codes, MS- DRG , APR DRG , POA, SOI & ROM assignments. ESSENTIAL FUNCTIONS: 1. Knows,… more
- St. Luke's University Health Network (Allentown, PA)
- …claims data and coding of all diagnosis and procedure codes to assure properly assigned MS- DRG or APR- DRG for the purpose of appealing proposed DRG and ... reviews for clinical validation of diagnosis and procedure code assignment and MS- DRG /APR- DRG accuracy based on denials or audit findings from government and… more
- Marshfield Clinic (Marshfield, WI)
- …Uniform Hospital Discharge Data Set (UHDDS) and assignment of the appropriate MS- DRG (Medicare Severity-Diagnosis Related Group) or APR- DRG (All Patients Refined ... co-morbidities and complications, secondary conditions, surgical procedures and/or other procedures. + MS- DRG /APR- DRG + Present on admission indicators + HAC… more
- RWJBarnabas Health (Oceanport, NJ)
- …responsible for ensuring accuracy and integrity of ICD-10-CM/PCS coding and DRG assignment for inpatient encounters for other payers (not Medicare/Managed Medicare). ... the accuracy and integrity of ICD-10-CM/PCS, CPT coding when applicable and DRG assignment for adherence to Federal and State Regulations and Compliance Guidelines.… more
- RWJBarnabas Health (Oceanport, NJ)
- …is responsible for ensuring accuracy and integrity of ICD-10-CM/PCS coding and DRG assignment for inpatient Medicare encounters. This requires critical thinking and ... the accuracy and integrity of ICD-10-CM/PCS, CPT coding when applicable and DRG assignment for adherence to Federal and State Regulations and Compliance Guidelines.… more
- Houston Methodist (FL)
- …of clinical documentation. This position analyzes medical records for DRG 's, complications, and comorbidities; identifies trends; and notes observations and ... and follows up as necessary. Tracks responses and trends completion of DRG /Documentation worksheets as pertinent to scope of department. + Conducts follow-up reviews… more
- Taco Bell (Kansas City, MO)
- …is between $13.75-$14.25 per hour depending on experience and availability! BENEFITS: * DRG Cares Grant Program - Grants to assist employees with life challenges and ... financial assistance * DRG Savings Marketplace- Exclusive access to discounts for DRG employees * Employee Assistance Program * Live Mas Scholarship Program *… more