- Elevance Health (Indianapolis, IN)
- …Skills, Capabilities and Experiences** : + BA/BS preferred. + Experience with vendor based DRG Coding / Clinical Validation Audit setting or hospital coding or ... ** DRG (DIAGNOSTIC RELATED GROUP) CODING AUDITOR** **Location** :...billing/payment systems provider billing guidelines, payer reimbursement policies, billing validation criteria and coding terminology preferred. + Knowledge of… more
- Crouse Hospital (Syracuse, NY)
- …or related field is required. Experience: Approximately 1 year IP coding and or DRG validation experience in an acute care setting required. 1- 2 years ... The DRG Denial Specialist works under the Inpatient Coding Manager and oversees compliance with coding standards and regulations. Advises and assists in… more
- Elevance Health (Columbus, OH)
- …Coding Credential such as CCS or CIC. + Experience with third party DRG Coding and/or Clinical Validation Audits or hospital clinical documentation improvement ... **Diagnosis Related Group Clinical Validation Auditor** **Location:** This position will work a...and reimbursed. Specializes in review of Diagnosis Related Group ( DRG ) paid claims. **How you will make an impact:**… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The purpose of DRG validation is to confirm that diagnostic, procedural information, and the discharge status of the beneficiary, as coded ... CRM works in conjunction with the Associate Director and Director of DRG Validation to help develop coding education and training and institutional coding… more
- Marshfield Clinic (Ladysmith, WI)
- …concerns and DRG assignments + Assists in the preparation of responses to DRG validation requests and other third party payer inquiries related to coding and ... Uniform Hospital Discharge Data Set (UHDDS) and assignment of the appropriate MS- DRG (Medicare Severity-Diagnosis Related Group) or APR- DRG (All Patients Refined… more
- University of Michigan (Ann Arbor, MI)
- …additional diagnoses and/or procedures that impact (this is not an exhaustive list) DRG assignment, PSI, HAC, SOI, ROM, POA and Risk O:E., risk adjustment and ... Serves as an escalation point for CDI, coding, and/or quality discrepancies (ie, DRG mismatch, missing query response, code change, etc.). + Performs audits on CDIS… more
- Tidelands Health (Murrells Inlet, SC)
- …point of contact for CDI and other team members when the supervisor/ manager is not available. **Position Responsibilities & Functions** + Assigns and sequences ... and Risk of Mortality (ROM), best Diagnostic Related Group ( DRG ) outcome, and accurate assignment of present on admission...Integrity (CDI) team as part of the clinical documentation validation , to provide the most accurate and complete diagnoses.… more
- R1 RCM (Chicago, IL)
- …workflow orchestration. As our Software Engineering Manager , you will help the DRG Validation and Charge Capture Service Line make auditors more efficient so ... that they can process opportunities even quicker. Every day you will help your team stay unblocked. To thrive in this role, you must be well organized and be able to create an outstanding team culture. **Here's what you will experience working as a (position… more
- Covenant Health Inc. (Knoxville, TN)
- …record, the accuracy of documentation, and the appropriate assignment of a final DRG . The CDI specialist functions as an onsite resource for clinical staff and ... discharge planning of patients. In order to assure appropriate DRG assignment and the validity and reliability of the...in the diagnosis and treatment of the patient. The validation of the clinical diagnoses is an additional focus… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …+ Basic understanding of clinical and payment methodologies including per diems, APC, DRG , MPFS, CCI, etc. required. + Must have extensive knowledge of SQL including ... months. **ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS** + Works closely with the Manager , Healthcare Price and Transparency to continually refine, implement, automate,… more
- Molina Healthcare (Lexington, KY)
- …reports quality of care issues. + Assists with Complex Claim review including DRG Validation , Itemized Bill Review, Appropriate Level of Care, Inpatient ... Certified Clinical Coder, Certified Medical Audit Specialists, Certified Case Manager , Certified Professional Healthcare Management, Certified Professional in… more