- UnitedHealth Group (Los Angeles, CA)
- …Physician will provide expertise and leadership on population, specifically Clinical Documentation Review with expertise in application of DRG coding and ... DRG -based clinical reviews within the Optum Enterprise Innovative DRG Clinical Review program and be an excellent written and spoken communicator (eg,… 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
- Baptist Health (Alabaster, AL)
- …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
- AdventHealth (Altamonte Springs, FL)
- …patient and involved care givers (as permitted by the patient) as well as a review of the current and past inpatient and outpatient medical record in the Initial ... team as needed. Establishes and documents, based on the predicted DRG and multidisciplinary team member's input, Anticipated Date of Transition (ADOT)… more
- St. Barnabas (Bronx, NY)
- …improvement strategies Conducts monthly analysis of Medicare/Medicaid/Third Party Payers Review and resolve issues related to claim generation and rejected/denied ... of hospital reimbursement and facility claims submission, collection and analysis ( DRG , APC, Managed Care contracting) Hospital denials and appeals management… more
- AdventHealth (Hinsdale, IL)
- …patient and involved care givers (as permitted by the patient) as well as a review of the current and past inpatient and outpatient medical record in the Initial ... team as needed. *Establishes and documents, based on the predicted DRG and multidisciplinary team member's input, Anticipated Date of Transition (ADOT)… more
- Phaxis (Bronx, NY)
- …- Knowledge of Provider Contracting - Knowledge of CPTs, ICD 9/ICD 10, HCPC, DRG , Revenue, RBRVS - Proficiency in MS Excel, Word, PowerPoint, and experience using a ... claims processing system or comparable database software JOB RESPONSIBILITIES INCLUDE: Review and resolve claims processed by external vendors, including provider… 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
- 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
- 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
- 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
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of ... all diagnosis and procedure codes to assure properly assigned MS- DRG or APR- DRG for the purpose of...appropriate reimbursement. + Work with the physician advisor in review of patient medical records identified by RAC/MIC/QIO and… more
- Dignity Health (Carmichael, CA)
- **Responsibilities** **Day Per Diem Utilization Review Registered Nurse - Onsite Campus Position** The **Utilization Review RN** is responsible for the review ... in collaboration with the attending physician, consultants, second level physician reviewer and the Care Coordination staff utilizing evidence-based guidelines and… more
