- HCA Healthcare (Nashville, TN)
- …Sign-On Bonus Eligible* Do you have the career opportunities as an Inpatient Coding Denial Specialist you want with your current employer? We have an exciting ... Do you want to work as an Inpatient Coding Denial Specialist where your passion for creating...denial /downgrade + Explanation of Benefits/Remittance Advice + Payer denial / DRG downgrade letters + Complex NCD/LCD guidelines,… more
- Banner Health (AZ)
- …looking to leverage your abilities - apply today. The Registered Nurse RN Denial Management Specialist is responsible for reviewing concurrent inpatient denials ... for coverage issues, payor outliers, split billing, disallowed charges, incorrect DRG codes, denial and compliance issues. 3. Quantifies, analyzes,… more
- St. Luke's University Health Network (Allentown, PA)
- …outlined in current Performance Improvement Plan. 8. Maintains 95% accuracy of coding and DRG denial decision to appeal rate as measured through quality reviews. ... ability to pay for health care. The Coding Appeals Specialist retrospectively reviews patient medical records, claims data and...encounters and CPT assignment for OP encounters. 2. Analyze DRG or CPT denial letters and draft… more
- University of Miami (Hialeah, FL)
- …multidisciplinary teams. The concurrent inpatient quality reviewer will assign a working DRG , as well as capture and ensure accurate POA assignment, severity of ... the health record. + Examine and ensure that the MS- DRG , APR- DRG , SOI, and ROM of each...with orders. + Communicates professionally identified discrepancies, documentation issues, denial management issues and coding concerns in the medical… more
- Granville Health System (Oxford, NC)
- …and assisting in provider documentation training. Responsible for appealing any insurance denial or DRG downgrade based on documentation and coding issues. ... Summary:#The CDI Specialist is responsible for improving the overall quality...diagnoses, principal and secondary procedures concurrently to promote appropriate DRG , APC, and ER Leveling assignments. Responsible for identifying… more
- Vanderbilt University Medical Center (Nashville, TN)
- …between the organization, payers and patients independently. Analyzes and reports on insurance denial causes and trends. Acts as a resource and mentor for peers. . ... (Intermediate): Ability to assign and interpret ICD-10-CM/PCS coding classification systems and MS- DRG and APR- DRG prospective payment and severity systems. *… more
- LifePoint Health (Brentwood, TN)
- …initiatives to hospital leadership. This position also provides oversight to the DRG Downgrade Appeals Specialist team. *Responsibilities:* . Oversee the ... . Assure appropriate action is taken within appeal time frames to address DRG downgrade denial . . Serve as subject matter expert on denial rationales and… more
- Prime Healthcare (National City, CA)
- …and payment of claims. The Biller is responsible for the follow-up and denial management as necessary for final resolution. Responsible to identify the various types ... of diagnosis and procedures codes (ICD9, CPT, HCPCS, DRG ) as they relate to reimbursement. Communicates clearly and efficiently by phone and in person with clients… more
- Trinity Health (Livonia, MI)
- …and secondary procedures. Assigns appropriate Medicare Severity Diagnosis Related Groups (MS- DRG ), All Patient Refined DRGs (APR), Present on Admission (POA), as ... of Diseases, Clinical Modification (ICD-CM) diagnosis and procedure codes, MS- DRG , APR DRG , POA, SOI & ROM...(PBS) teams, when needed, to help resolve billing, claims, denial and appeals issues affecting reimbursement. Maintains CEUs as… more
- Trinity Health (Livonia, MI)
- …and secondary procedures. Assigns appropriate Medicare Severity Diagnosis Related Groups (MS- DRG ), All Patient Refined DRGs (APR), Present on Admission (POA), as ... of Diseases, Clinical Modification (ICD-CM) diagnosis and procedure codes, MS- DRG , APR DRG , POA, SOI & ROM...(PBS) teams, when needed, to help resolve billing, claims, denial , and appeals issues affecting reimbursement. 10. Maintains CEUs… more
- Fairview Health Services (St. Paul, MN)
- …and activate strategies and tactics to identify documentation opportunities using internal DRG pairs and triplets to national data sources to achieve improved ... as a resource and helps to validate post claim DRG downgrade denials related to coding and clinical determination...to support appeal strategy, tracking by disease, payer and denial activity and works with teams to create transparency… more
- University of Rochester (Rochester, NY)
- …resubmission, and, acting as a point of contact for coding inquiries, education, and DRG denial trends between HIM, UM, PFS, and Compliance departments. **Of ... monitors, and coordinates the identification, investigation, and resolution of provider DRG denials and grievances following state and federal regulations and… more
- University of Rochester (Rochester, NY)
- …assigned staff in Coding areas. Oversees simple visit coding and coding denial coding staff to ensure timely and accurate classification and abstracting of ... facility required or an equivalent combination of education and experience. + DRG /APC/AGG assignment experience required preferably in a tertiary care facility or… more