- HSS (New York, NY)
- …committed to our Mission, you too can be part of our transformation across the enterprise. DRG Reviewer Full-Time The DRG Reviewer reports to the ... Director of Coding, HIM (Health Information Management). The DRG Reviewer oversees DRG accuracy....+ Monitors coding and documentation accuracy. + Conducts retrospective review of the medical record to increase accuracy, clarity,… 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. Reg ... - Clinical Revenue Cycle Admin **Job Description:** The Director, Clinical & DRG Denials provides clinical leadership and administrative guidance to the Clinical… more
- The Mount Sinai Health System (New York, NY)
- Maintains responsibility for coding/ DRG validation review , DRG PRO activities and assurance of optimal reimbursement. Oversees compliance with coding ... standards and regulations **Strength Through Diversity** The Mount Sinai Health System believes that diversity, equity, and inclusion are key drivers for excellence. We share a common devotion to delivering exceptional patient care. When you join us, you… more
- Brooks-TLC Hospital System, Inc (Dunkirk, NY)
- …Management, Quality Department and ancillary staff to perform concurrent analytical review of clinical documentation and coding data.The CDS facilitates obtaining ... an accurate reflection of the patient condition in the associated DRG assignments, case-mix index, documentation/coded quality metrics, and reimbursement. The CDS… more
- Kaleida Health (Buffalo, NY)
- …Management, Quality Department and ancillary staff to perform concurrent analytical review of clinical documentation and coding data. The CDS facilitates obtaining ... an accurate reflection of the patient condition in the associated DRG assignments, case-mix index, documentation/coded quality metrics, and reimbursement. The CDS… more
- Banner Health (New York, NY)
- …identify possible opportunities for improvement of clinical documentation and accurate MS- DRG , Ambulatory Payment Classification (APC) or ICD-9 assignments on health ... and its impact on reimbursement under Medicare Severity Adjusted System (MS- DRG ), and Ambulatory Payment Classification (APC) or utilized operational systems… more
- Northwell Health (Lake Success, NY)
- …the Medical Record. Job Responsibility + Leverages clinical expertise to identify and validate DRG code assignment + Full review of CDI suggested code changes + ... + Applies coding rules and regulations to the validation review process. + Reviews codes on Medicare/non-Medicare charts for...charts for compliance to rules and conventions. + Communicates DRG changes and rationale to the coding and CDI… more
- Intermountain Health (Albany, NY)
- …Integrity (CDI) Registered Nurses (RN) and Intermountain Physician Advisors to review complex facility encounters and assign International Classification of Diseases ... ICD-10 and Diagnosis Related Groups ( DRG ) codes for claims concurrently while a patient is...reviews while patients are hospitalized. It aids in the review of quality measures including Patient Safety Indicators and… more
- Kaleida Health (Buffalo, NY)
- …Management, Quality Department and ancillary staff to perform concurrent analytical review of clinical documentation and coding data. The CDS facilitates obtaining ... CDS exhibits a sufficient knowledge of clinical documentation requirements, DRG assignment, and clinical conditions and/or procedures. Coaches/teaches leaders using… more
- WMCHealth (Valhalla, NY)
- …to the Supervising Medical Records Coder. . Participates in mandated medical record review processes. . Using current HCPCS, ICD, and CPT coding systems, assigns and ... medical record. . Ensures that all factors necessary for assigning an accurate DRG are present, and that all diagnoses are ranked properly. . Makes appropriate… more
- Mohawk Valley Health System (Utica, NY)
- …barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of cases to ensure compliance with regulatory requirements, hospitals objectives, ... appropriateness of admission and continued stay, severity, and morbidity/mortality. + Review patient status when admission criteria is non-sufficient for admission.… more
- University of Rochester (Rochester, NY)
- …reviews and assigns appropriate codes (eg ICD-diagnosis, CPT, HCPCS and modifiers, DRG ) from appropriate coding classification system to assure the production of ... AND RESPONSIBILITIES:** 1. Uses knowledge of coding systems and system logic to review codes created by electronic charge capture and/or assign appropriate codes (eg… more
- Guthrie (Binghamton, NY)
- …and Compliant assigning of CPT procedure code, modifiers, and appropriate assignments of DRG 's/ APC's. Coding staff will abide by the standards of ethical coding as ... Credits. Productive and Accurate. Working knowledge of disease processes, MS‐ DRG and APC classification and reimbursement structures, applicable coding edits… more
- Guthrie (Binghamton, NY)
- …clinical experience in a hospital setting required. Critical care, utilization review or coding experience required. Requires excellent communication skills (both ... guidelines. 2. Demonstrates knowledge of CDMP guidelines and program, DRG payor issues, documentation opportunities, clinical documentation requirements, and… more
- Glens Falls Hospital (Glens Falls, NY)
- …Glens Falls Hospital submits codes that reflect the acuity of our patient and DRG 's that include all MCC's and CC's for reimbursement. In collaboration with Hospital ... External Review Team (HERT) members, coordinates reviews and responds to...offer expertise in the area of documentation, coding and DRG methodologies. Performs ongoing monitoring for coding quality and… more
- Ellis Medicine (Schenectady, NY)
- …comprehensive integration of Discharge Planning, Performance Improvement and Utilization Review activities at patient, hospital, and system levels. 2. Efficiently ... of issues through pre-admission, admission, concurrent and post discharge medical record review 3. Services as a consultant, provides guidance to the healthcare team… more
- University of Rochester (Rochester, NY)
- …of clinical specialties as assigned by Director of Compliance through review , analysis, communication and training activities. Determines compliance with billing ... billing code and level. + Prepares and submits reports containing review findings. Identifies areas requiring change. Makes recommendations for corrective action… more
- Catholic Health Services (Bethpage, NY)
- …Educate staff, physicians, patients, and families in the case management process. Review new admissions and continued stay patients to determine whether MCG criteria ... is met. Engage physicians to establish the optimal DRG , length of stay and expected date of discharge....for reviews in a timely fashion to avoid denials. Review records and collaborate with the interdisciplinary team to… more
- University of Rochester (Rochester, NY)
- …accordance with applicable coding rules and policies (eg ICD-10, CPT-4, HCPCS, DRG ). Analyzes, enters and manipulates database. Responds to or clarifies internal ... + ses thorough knowledge of coding systems and system logic to review codes created by electronic charge capture and/or assign codes (ICD-10-CM, E/M,… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …and identifying any deficiencies. + Prepare summaries for management of quality review results, including basic analysis of identified trends. + Analyzes audit ... for workflow enhancements. + Evaluates Prospective Payment System (PPS) (eg APC, DRG , etc.) grouping and pricing information. + Meets individual and departmental… more