- Zelis (Morristown, NJ)
- Position Overview: The Nurse Reviewer is primarily responsible for conducting post-service, pre or post payment in-depth claim reviews based on accepted medical ... billing and coding rules, plan policy exclusions, and payment errors/overpayments. Conduct review of facility and outpatient bills as it compares with medical… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The DRG Appeals Analyst - CDI Liaison is responsible for analyzing medical records, claims data, and coding on all diagnoses and procedures (both ... and surgical) to assure properly assigned diagnostic related grouping ( DRG ) for purposes of appeal. This individual assures that...assigned by the client was properly assigned based upon review of the medical documentation and application of the… more
- Hackensack Meridian Health (Hackensack, NJ)
- …Health Information Management (HIM) education. + Minimum of 5 years progressive coding review in ICD-10-CM and DRG methodologies. + Knowledge of POA/HAC, PSI ... serve as a leader of positive change. The **Diagnosis Related Group ( DRG ) Auditor** is responsible for auditing clinical documentation that supports code assignment… 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
- Zelis (Morristown, NJ)
- Position Overview: The Bill Review Operations Analyst will provide daily operational support to the Expert Claims Review team, including the itemized bill ... review , clinical chart review , and document retrieval teams. Responsibilities include reporting, claims management, analysis, client savings identification,… more
- Hackensack Meridian Health (Hackensack, NJ)
- …Meridian** **_Health_** includes: + Reviews Diagnosis Related Group ( DRG ) assignment for selected Medicare/Medicaid inpatients, Hospital-acquired condition (HAC), ... + Provides guidance on any changes made during their review to the Inpatient Coders by furnishing input as...and rationale (if needed) in 3M as needed for DRG mismatches on Clinical Documentation Improvement (CDI) reviewed cases.… 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
- Elevance Health (Morristown, NJ)
- …clinical documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group ( DRG ) paid claims. **How you will ... improvement, and a minimum of 5 years of experience working with ICD-9/10CM, MS- DRG , AP- DRG and APR- DRG ; or any combination of education and experience,… more
- Hackensack Meridian Health (Hackensack, NJ)
- …and ICD-10-Procedure Coding System (PCS) codes creating diagnosis-related group ( DRG ) assignments. Abstracts pertinent information from patient records. + Sequence ... the diagnosis and procedures using coding guidelines and optimizing the DRG as applicable. + Addressing all edits, including but not limited to nosology, Exihauser,… more
- Mount Sinai Health System (Brooklyn, NY)
- …Thorough knowledge of Medical Terminology, ICD-9-CM and ICD-10 coding, as well as DRG logic and CRT coding. Thorough knowledge of current coding guidelines. + ... Coder - THIS IS AN ON-SITE POSITION** 1. Thoroughly review , analyze, and interpret the entire medical record (electronic...software to assign diagnosis and procedure codes and respective DRG . Utilize the clinical analyzer to assist in refining… more
- WMCHealth (Valhalla, NY)
- …to the the coding leadership team. + Participates in mandated medical record review processes. + Using current ICD coding systems, assigns and records an accurate ... medical record. + Ensures that all factors necessary for assigning an accurate DRG are present, and that all diagnoses are ranked properly. + Makes appropriate… more
- BronxCare Health System (Bronx, NY)
- …levels of care. - Maintain knowledge of Managed Care requirements, DRG , insurance benefits, IPRO regulations and nationally recognized medical necessity criteria. ... findings in cooperation with other health care professionals. Preparation of Patient Review Instrument (PRI) Screen, Case form, AIDS chronic care package required.… more
- BronxCare Health System (Bronx, NY)
- …of illness/intensity of service guidelines. The CDS will work with hospital top DRG 's to insure that documentation is optimal and meets coding clinic guidelines in ... improvements and educational outcomes. Responsibilities + Provides concurrent and retrospective review of the clinical documentation in the medical record; review… more
- Hackensack Meridian Health (Hackensack, NJ)
- …Ensure modification to Reimbursement Contract Management system is working efficiently. + Ensure DRG in the EPIC system are upgraded or loaded to current versions ... timely. + Ensure that established functional standard of productivity is met. Review staff performance in relationship to the standard established. Responsible for… more
- New York eHealth Collaborative (New York, NY)
- …interoperability knowledge across the NYeC team. + Lead enterprise Architecture Review Board (ARB). + Knowledgeable about industry trends, experiences and approaches ... in the use of clinical terminology such as LOINC, ICD9, SNOMED/CT, HCPCS, DRG . + Experience and knowledge of healthcare interoperability preferred. Such as HL7, CDA,… more
- Mount Sinai Health System (New York, NY)
- …FT Days M-F 8AM-4PM** The Coding Specialist III is responsible for the review and coding of complex inpatient and/or ambulatory surgery records utilizing ICD-10-CM ... care hospital. Proficiency in the use of automated coding and DRG /APC grouping software. **Licensing and Certification Requirements (if applicable)** Name: Certified… more
- Mount Sinai Health System (New York, NY)
- …Healing made personal. **_Roles & Responsibilities:_** + Responsible for the review and coding of complex inpatient and/or ambulatory surgery records utilizing ... preferred. Experience: Proficiency in the use of automated coding and DRG /AOC grouping software. **_Strength Through Diversity_** The Mount Sinai Health System… more
- BronxCare Health System (Bronx, NY)
- Overview Review clinical documentation and diagnostic results as appropriate to extract data and apply appropriate ICD-10-CM and ICD 10-PCS codes for billing, ... and other required data into the clinical information system for accurate DRG assignments. Identifies non-payment conditions (HAC) and when required, report through… 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