- Mass General Brigham (Somerville, MA)
- …what it means to be part of Mass General Brigham. Job Summary Perform DRG validation and quality audit on claims, providing coding expertise in the application of ... and reimbursement policies within the claim adjudication process through document review , interpretation of state and federal mandates, applicable benefit language,… more
- American Traveler (Washington, DC)
- …and Core Measures, *Must be able to use CPT coding, ICD-10 coding, and DRG systems, *Knowledge of HIPAA, OSHA, CMS, and The Joint Commission standards, *Bachelor of ... Science in Nursing (BSN) preferred, *Two supervisor references required for consideration, *Return staff must have been separated from previous employment for at least 1 year to be eligible, Additional Information *Responsibilities include care coordination,… more
- MedReview (New York, NY)
- …and providing resolutions. Knowledge of HIPAA privacy information standards required. Knowledge of DRG Validation Review , Cost Outlier Review and Readmission ... As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews. Under the direction of the… more
- CERiS (Fort Worth, TX)
- …Ability to use clinical judgement and analytical skills to appropriately review documentation submitted for claim audits. Utilize clinical judgement to appropriately ... as it relates to reviews done by CERIS such as itemized bill, DRG and/or specialty audits. Utilize applicable tools and resources to complete internal audits… more
- Roessel Joy (Norwell, MA)
- …Process and submit medical billing claims to insurance companies and government payers. Review patient records to ensure proper coding using ICD-10, ICD-9, and ... DRG classifications. Follow up on unpaid claims and resolve...practices. Requirements Proficiency in medical coding, particularly ICD-10 and DRG systems. Strong understanding of medical office operations and… more
- Conifer Health Solutions (Sherwood, AR)
- …documentation. Exhibits a sufficient knowledge of clinical documentation requirements, MS- DRG Assignment, and clinical conditions or procedures. Educates members of ... DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. Record Review : Completes initial medical records reviews of patient records within 24-48… more
- Hoag Memorial - Red Hill Clinic (Costa Mesa, CA)
- …the use of the contract management tool for proper pricing (Examples: APC, DRG , APRDRG). *Reviews and initiates the initial appeal for underpayments, observing all ... *Reports new/unknown billing edits to the direct supervisor for review and resolution. *Has a strong understanding of the...in full at the time payment is due. *May review applicable cash rates, special rates, and applicable professional… more
- Sutter Health (Modesto, CA)
- …team, nursing management, quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted ... management within a managed care environment. Comprehensive knowledge of Utilization Review , levels of care, and observation status. Awareness of healthcare… more
- Sutter Health (Burlingame, CA)
- …team, nursing management, quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted ... management within a managed care environment. Comprehensive knowledge of Utilization Review , levels of care, and observation status. Awareness of healthcare… more
- The Judge Group Inc. (Philadelphia, PA)
- …evaluation Discharge planning Use of InterQual and Milliman guidelines Utilization Review Admission criteria Appeals and denials Concurrent and continued stay ... reviews Retrospective review Medical necessity assessments Regulatory Compliance CMS CPT coding...Compliance CMS CPT coding and billing Department of Health DRG HEDIS measures HIPAA ICD-10 coding NCQA OSHA The… more
- State of Nebraska (Lincoln, NE)
- …Recommend changes and draft proposals. Evaluate managed care plan applications, coordinate review by other court staff as needed. Submit reports and recommendations ... to the Regulatory Programs Manager for review . Review amendments to, contracts with, and...Participate in reviewing, researching, and implementing revisions to the DRG Schedule and the fee schedules adopted by the… more
- UPMC (Pittsburgh, PA)
- …compliance with coding guidelines, third-party payer and OIG regulations. **Responsibilities:** + Review and evaluate focused UPMC DRG medical records for ... UPMC Corporate Revenue Cycle is hiring a DRG Specialist to work on inpatient auditing within...years of coding experience. In this role, you will review clinical documentation within the medical record to ensure… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …to educate physicians, nursing, and other clinical staff to improve documentation. + Review ?s DRG Reassignment letters and assists in formulating Appeal letters ... leadership programs and more! **Description** We are seeking an experienced **Inpatient DRG Coding Auditor** to extract data from patient encounters ensuring the… more
- Mount Sinai Health System (New York, NY)
- …of the DRG assignments flagged pre-billing. Determines if a secondary review is required to verify assignment of Patient Safety Indicators, HAC, Clinical ... **Job Description** The purpose of DRG validation is to confirm that diagnostic, procedural...Improvement,Sepsis and any other charts meeting criteria for secondary review . Initiates an MD query to clarify documentation in… more
- Elevance Health (Grand Prairie, TX)
- …clinical reviews of medical records and other documentation to evaluate issues of coding and DRG assignment accuracy. Specializes in review of DRG coding via ... ** DRG CODING AUDITOR** **_Virtual_** **_: _** _ _...to recover, eliminate and prevent unnecessary medical-expense spending. The ** DRG CODING AUDITOR** is responsible for auditing inpatient medical… 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
- HCA Healthcare (Brownsville, TX)
- …want to join an organization that invests in you as a Coding Quality Audit Reviewer ? At Parallon, you come first. HCA Healthcare has committed up to $300 million in ... remote/work from home!** **Schedule: Monday-Friday Day Shift** **Must have DRG Validation experience and Inpatient Coding experience** **Benefits** Parallon, offers… more
- AdventHealth (Altamonte Springs, FL)
- …collaboration with physicians, nursing and HIM coders, the Second Level Reviewer I strategically facilitates and obtains appropriate and quality physician ... complexity of care of the patient. The Second Level Reviewer I educates members of the patient care team...(ROM), and quality. . Completes accurate and timely record review to ensure the integrity of documentation compliance. .… more
- SSM Health (MO)
- …the principal diagnosis, pertinent secondary diagnoses, and procedures for accurate diagnosis review group ( DRG ) assignment, risk of mortality (ROM), and ... reflection of the patient condition in the associated Diagnosis Related Group ( DRG ) assignments, case-mix index, severity of illness (SOI), and risk of mortality… more
- Kaleida Health (Buffalo, NY)
- …and insurance / managed care practices including but not limited to: utilization review , RAC, MAC, Q10, clinical and DRG denial management required. **Working ... **Director Clinical and DRG Denials** **Location:** Larkin Bldg @ Exchange Street...Shift 1 Job Description **Summary:** The Director, Clinical & DRG Denials provides clinical leadership and administrative guidance to… more
