- 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
- 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
- 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
- Catholic Health Services (Smithtown, NY)
- …serves as a resource to improve capture and accuracy of the final coded DRG ; able to meet daily production expectations, while impacting on the integrity of the ... query practice. Follow open queries to ensure physician response. Validates DRG assignment with medical record documentation, ICD-10-Official Coding guidelines 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 ... an accurate reflection of the patient condition in the associated DRG assignments, case-mix index, documentation/coded quality metrics, and reimbursement. The CDS… 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
- 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
- Catholic Health Services (Rockville Centre, NY)
- …required. CCDS certification required within 2 years of hire date Skills: Chart review skills with ICD 10CM.PCS experience preferred. Experience: Minimum of 5 years ... and procedures where inadequate or conflicting documentation exists. Verifies DRG assignment with medical record documentation and consults with...level of service rendered to all patients with a DRG based payor. Demonstrates knowledge of DRG … more
- Catholic Health Services (Rockville Centre, NY)
- …is received for the level of service rendered to all patients with a DRG based payor. Ensures the accuracy and completeness of clinical information used for ... received for the level of service rendered to all patients with a DRG based payor. Demonstrates proficiency in clinical documentation requirements for the accurate… 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
- Loretto Management Corporation (Syracuse, NY)
- …etc. In addition, the Specialist will identify, collect, assess, monitor and review documentation and encounter coding as it pertains to Clinical Coding Categories ... or denied claims from PACE CNY contracted providers. Completes medical chart review related to such claims and provides feedback to the Health Information… more
- University of Rochester (Rochester, NY)
- …Wilmot and Pluta Cancer Treatment Centers, Laboratories, and Radiology. **Reimbursement Review and Calculation of Costs** + Retrieval and dissemination of both ... schedule and insurance reimbursement matrixes. + Must perform contract review and ensure that the proper reimbursement rates are...utilized by determining if payments will be based on DRG , APC, fee schedule, percentage of charges, or any… 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
- Kaleida Health (Buffalo, NY)
- …with federal and state regulations. Diagnoses and procedures are coded through review of the entire medical record, utilizing the International Classification of ... 1 year of experience in coding with ICD 10, PCS, CPT Coding and DRG /APC assignment in an acute care facility preferred. Prior experience with computerized software… more
- Northwell Health (Riverhead, 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
- Bassett Healthcare (Cooperstown, NY)
- …liaison between emergency services, surgical services, nursing, finance, physicians, utilization review and medical records to ensure appropriate bed is assigned, ... aligned according to patient's clinical progression. Reviews LOS values and working DRG daily. Proactively monitors patients in observation or outpatient status and… more