- Elevance Health (Louisville, KY)
- … Coding Credential such as CCS or CIC. + Experience with third party DRG Coding and/or Clinical Validation Audits or hospital clinical documentation ... **Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS- DRG , AP- DRG...+ Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance… more
- Molina Healthcare (Louisville, KY)
- …care issues. + Assists with complex claim review including diagnosis-related group ( DRG ) validation , itemized bill review, appropriate level of care, inpatient ... readmissions. + Validates member medical records and claims submitted/correct coding , to ensure appropriate reimbursement to providers. + Resolves escalated… more