- 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
- Molina Healthcare (Columbus, OH)
- …auditing, ideally in a DRG / Clinical Validation * 3+ years of Utilization Review and/or Medical Claims Review experience. * 3+ years Managerial Experience * ... **Job Description** **Job Summary** The Manager, Clinical DRG Coding & Validation must have an extensive...audit letters, train team members. * Manage medical claim review team nurses, ensure operational goals are meet and… 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
- Elevance Health (Norfolk, VA)
- …of the Company, for all lines of business, and its clients. Specializes in review of DRG coding via medical record and attending physician's statement provided ... ** DRG Coding Auditor Principal** _Virtual: This role enables...and skill development. Alternate locations may be considered._ The DRG Coding Auditor Principal is responsible for auditing inpatient… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- Position Purpose: The Clinical Reviewer serves as a subject matter expert in the clinical review of claims, claim disputes, appeals and FWA special ... investigations Responsibilities: + Review of facility claim disputes including clinical records, itemized...+ Minimum 5-7 years of experience as a clinical reviewer of facility claims in a Medicare Advantage environment,… 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)
- …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 (Santa Fe, NM)
- …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
- Insight Global (Miami, FL)
- Job Description Insight Global is looking to hire 2 remote Inpatient DRG Coding Specialists for a healthcare provider in the South Florida area. We are seeking a ... detail-oriented and experienced Inpatient DRG Coding Specialist to join our Health Information Management team. The ideal candidate will be responsible for… 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 ... retrospective medical record reviews for diagnosis and procedure code assignment and MS- DRG accuracy for inpatient encounters and CPT assignment for OP encounters.… 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
- 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 ... and integrity of ICD-10-CM/PCS, CPT coding when applicable and DRG assignment for adherence to Federal and State Regulations...a team with other Quality Officers to ensure SMART review goals are met for all RWJBarnabas facilities. +… more
- RWJBarnabas Health (West Orange, NJ)
- …responsible for ensuring accuracy and integrity of ICD-10-CM/PCS coding and DRG assignment for inpatient Managed Medicare encounters. This requires critical thinking ... and integrity of ICD-10-CM/PCS, CPT coding when applicable and DRG assignment for adherence to Federal and State Regulations...a team with other Quality Officers to ensure SMART review goals are met for all RWJBarnabas facilities. +… more
- Kaleida Health (Buffalo, NY)
- …Patient Financial Services, Corporate Compliance, Clinics, and Ancillary depts to perform and review the coding and DRG assignment for accuracy. Serves as the ... liaison between coding specialists and clinical documentation specialists for DRG Mismatch and reconciliation of case variation. Ensures all inpatient and outpatient… 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). ... and integrity of ICD-10-CM/PCS, CPT coding when applicable and DRG assignment for adherence to Federal and State Regulations...a team with other Quality Officers to ensure SMART review goals are met for all RWJBarnabas facilities. +… more
- Sutter Health (Sacramento, CA)
- …acuity and risk for mortality, in addition to Direct Report Groups ( DRG ) assignment. **Job Description** : **EDUCATION:** + Doctorate: Graduate of an accredited ... a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Some...Sub-acute, Acute rehab. + Proficient Knowledge of coding and DRG assignment process preferred. + Must be able to… more
- Houston Methodist (LA)
- …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