- Centene Corporation (Helena, MT)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Perform clinical/ coding medical claim review to ensure compliance with ... coding practices through a comprehensive review and analysis of medical claims, ...directives, precedent, AMA and CMS code edit criterion + Review medical records to ensure billing is… more
- Elevance Health (Roanoke, VA)
- …for all lines of business, and its clients. Specializes in review of DRG coding via medical record and attending physician's statement provided by ... Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The ** DRG Coding ...eliminate and prevent unnecessary medical -expense spending. The ** DRG Coding Auditor Principal** is responsible for… more
- Penn Medicine (Philadelphia, PA)
- …Rd 4th Floor Bala Cynwyd Hours: M-F, 8a-430p or similar Review coded medical records for coding and DRG and/or Evaluation and Management accuracy ... the following, but not limited to, areas: subject focused, purely randomized, CPT-4 Coding , Systemic Monitoring and Review Technology (SMART) audits on 100%… more
- Zelis (FL)
- …policy exclusions. Conduct reviews on inpatient DRG claims as they compare with medical records ICD-10 Official Coding Guidelines, AHA Coding Clinic and ... that shape who you are. Position Overview The Inpatient DRG Reviewer will be primarily responsible for...and billing rules + Clinical skills to evaluate appropriate Medical Record Coding + Experience conducting root… more
- Zelis (NJ)
- …clients. Conduct reviews on inpatient DRG claims as they compare with medical records utilizing ICD-10 Official Coding Guidelines, AHA Coding Clinic ... evidence supplied by the provider in the form of medical records such as physician notes, lab tests, images...conduct training for new team members + Identify new DRG coding concepts to expand the … more
- Excellus BlueCross BlueShield (Rochester, NY)
- …minimal direction or oversight. . Acts as an expert in reviewing medical coding and medical record review with ability to oversee complex assignments, ... Job Description: Summary: The Payment Integrity DRG Coding & Clinical Validation Analyst...I . Analyzes and audits acute inpatient claims. Integrates medical chart coding principles, clinical guidelines, and… more
- Hartford HealthCare (Farmington, CT)
- …Responsibilities:_** **Key Areas of Responsibility** *Denial Resolution* . Conduct a thorough review of medical records, coding and clinical documentation ... Work closely with the Clinical Documentation Improvement (CDI) and Coding teams to ensure accurate DRG assignment...to DRG validation. * Ability to analyze medical records, coding documentation, and payer denial… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …leadership programs and more! **Description** We are seeking an experienced **Inpatient DRG Coding Auditor** to extract data from patient encounters ensuring ... nursing, and other clinical staff to improve documentation. + Review ?s DRG Reassignment letters and assists...an acute care setting. + Previous experience in performing DRG coding audits. + Possesses knowledge of… more
- Penn Medicine (Lititz, PA)
- …regulations, and accuracy for clinical care analysis and provider profiling. Review coded medical records for coding and DRG accuracy by verifying that ... cross training to existing staff as needed. + Research, review and respond to coding and ...Identify and communicate documentation issues and concerns that influence coding , DRG assignment, and severity of illness… more
- Cedars-Sinai (CA)
- …Documentation Improvement (CDI) data, collaborating extensively with CDI staff and leadership, and medical records coding staff. + ** DRG Analysis:** Perform ... on Clinical Documentation Improvement Software and Executive Dashboard. + **Data Review :** Analyze clinical documentation, coding data, and quality metrics… more
- UTMB Health (Galveston, TX)
- Senior DRG Coder - RCO Coding **Galveston, Texas,...to provide optimal DRG assignment after thorough review of medical record and analysis of ... school or equivalent and three years of experience. The Sr. DRG coder must be proficient in inpatient coding with the ability to audit and provide education to… more
- Insight Global (South Jordan, UT)
- …provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology. Expert coding knowledge ( DRG & ICD-10) ... records and other documentation to evaluate issues of coding and DRG assignment accuracy. Below are...NOT A NURSE: Degree in RHIM, RHIA, RHIT with medical coding degree or just CCS is… more
- University of Michigan (Ann Arbor, MI)
- DRG COMPLIANCE AUDITOR (DCA) Apply Now **Job Summary** Review and check certain inpatient records to make sure the coding is correct and follows rules for ... of ICD-10 coding and understand the Official Coding Guidelines well. + Ability to review ...employer. **Job Detail** **Job Opening ID** 271520 **Working Title** DRG COMPLIANCE AUDITOR (DCA) **Job Title** Medical … more
- Elevance Health (Washington, DC)
- … Credential such as CCS or CIC. + Experience with third party DRG Coding and/or Clinical Validation Audits or hospital clinical documentation improvement ... the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group ( DRG ) paid...an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and… more
- HCA Healthcare (Nashville, TN)
- …growth, we encourage you to apply for our Coding Quality Audit Reviewer opening. We promptly review all applications. Highly qualified candidates will be ... vary by location._** Come join our team as a Coding Quality Audit Reviewer . We care for...policy + Demonstrates and applies expert level knowledge of medical coding practices and concepts + Participates… more
- SSM Health (MO)
- …the principal diagnosis, pertinent secondary diagnoses, and procedures for accurate diagnosis review group ( DRG ) assignment, risk of mortality (ROM), and ... Graduate of accredited school of nursing, PA, NP, or medical school, or Associate's degree and Certified Clinical Documentation...policies and trends, and healthcare economics. + Collaborates with coding to reconcile the DRG and resolves… more
- Insight Global (Plano, TX)
- …chart reviews to accurately reflect the patient's condition. Stay current with medical coding guidelines and industry developments. Assist in developing training ... Job Description Insight Global is seeking experienced DRG Auditors to join a remote healthcare organization....and quality audits on inpatient charts to ensure accurate coding and compliance with federal regulations. This is a… more
- WMCHealth (Valhalla, NY)
- …be responsible for coding reviews for the purpose of coding and DRG optimization. Must have thorough knowledge of medical terminology, ICD codes and ... in working with multiple computer applications and EMR systems. Responsibilities: + Review diagnostic, procedural and DRG assignments for validity and accuracy.… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …designation within one year of hire date. + Knowledge of medical record coding conventions (eg CPT, DRG , HCPCS, ICD10, etc.). + A general understanding of ... regulatory agencies. Essential Accountabilities: Level I + Functions as a clinical reviewer of medical records, researching and investigating complex medical… more
- SSM Health (MO)
- …mortality models, observed rate/expected rate (O/E ratios), industry trends, variable and diagnosis review group ( DRG ) frequency. + Serves as a liaison between ... interdisciplinary care team member, an auditor, and an educator ensuring medical records are complete and clinical documentation comprehensively represents the… more