- CERiS (Fort Worth, TX)
- …the end-to-end DRG audit process, from claim selection and clinical review to audit finding generation and appeal management. Oversee the entire clinical claims ... Position Summary: The DRG Audit Program Director is a strategic and... review process, understanding various client configurations and workflows. Ensure… more
- NYC Health Hospitals (New York, NY)
- …Diagnoses. Reconcile DRG with the Coders to avoid mismatches daily. Review Denials as assign. SUMMARY OF DUTIES AND RESPONSIBILITIES: 1. Apply knowledge of ... to improve the quality of care to the patient and enhance the DRG assignment, ultimately impacting reimbursement. AREAS OF RESPONSIBILITIES: Generate minimum of 8… more
- Conifer Health Solutions (Federal Way, WA)
- …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
- Valley Health (Winchester, VA)
- …the management of admission flow efficiency through appropriate patient status DRG /LOS assignment, and timely patient progression to achieve system efficiency. The ... against Milliman Care Guidelines (MCG) to identify admission status, working DRG and target LOS; communicates recommended status to physician; validates admission… more
- University Hospitals (Beachwood, OH)
- …status, outstanding revenue and to help identify trends (payer, physician, service, DRG , reviewer ). 20% Collaborate with supervisor to support training, and ... care *Decreased denials *Appropriate reimbursement Perform timely and accurate review , denial communications and construct appeals, including remaining current with… more
- Veterans Health Administration (Los Angeles, CA)
- …Initiates discharge planning upon admission. Applies InterQual Criteria and/or DRG and discusses with the interdisciplinary team. Attends daily Interdisciplinary ... standards of care and standards of practice preferred. Demonstrated ability to review patient clinical records and extract needed information in order to assess… more
- Orlando Health (Ocoee, FL)
- …of service, special/personal needs, and other relevant information. *Assigns working DRG and GMLOS, while concurrently monitoring and managing LOS, as appropriate ... advocate for patient's health care needs. *Performs admission and concurrent utilization review in compliance with review requirements for Managed Care… more
- Northwell Health (Great Neck, NY)
- …clinical documentation in the patient's medical record through a concurrent review process throughout the patient's inpatient stay. 4.Requests clarification of ... coding questions. 8.Demonstrates knowledge of ICD-10 CM and ICD-10 PCS coding, MS- DRG and APR NY and APR National grouper logic, documentation opportunities,… more
- Orlando Health (Clermont, FL)
- …o Accurate medical necessity screening and submission for Physician Advisor review o Care coordination that includes admitting diagnosis/ medical history, current ... special/ personal needs, and other relevant information. o Assignment of initial DRG to determine GMLOS, while concurrently monitoring and managing LOS and… 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
- 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 ... looking is an experienced and well-grounded medical coding auditor to quality review the inpatient hospital claims for proper reimbursement, handle provider disputes… more
- CVS Health (Hartford, CT)
- …Knowledge of Aetna clinical and coding policy and experience with appeals, claim review , reimbursement issues, and coding is preferable, but a willingness to learn ... Director role include support of the appeal process, clinical claim review process, pre-certification, and predetermination of covered benefits in the Commercial… more
