- UPMC (Pittsburgh, PA)
- UPMC Health Plan is looking for an Intermediate Clinical Auditor /Analyst to join the Quality Assurance team! This role will work standard daylight hours, Monday ... Tower, however, this role may work remotely. The Intermediate Clinical Auditor /Analyst is an integral part of...regulatory requirements, and resource utilization. This includes using vast clinical knowledge to ensure correct DRG procedural… more
- Elevance Health (Morristown, NJ)
- **Diagnosis Related Group Clinical Validation Auditor -RN** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live ... one of our PulsePoint locations. The **Diagnosis Related Group Clinical Validation Auditor ** is responsible for auditing...as CCS or CIC. + Experience with third party DRG Coding and/or Clinical Validation Audits or… more
- Hackensack Meridian Health (Hackensack, NJ)
- …a leader of positive change. The **Diagnosis Related Group ( DRG ) Auditor ** is responsible for auditing clinical documentation that supports code assignment ... this includes compliance with the Conditions of Participation for CMS. The DRG auditor is responsible for ensuring coding accuracy, coding consistency… more
- Highmark Health (Columbus, OH)
- …techniques, medical terminology and disease processes as it relates to the DRG /APC and other clinical data quality management factors. With technical ... II code and modifier assignments, ICD diagnosis and procedure coding, DRG /APC structure according to regulatory requirements. Reports findings both verbally and… more
- Houston Methodist (Houston, TX)
- …appropriate, utilizing the established physician query process. Provides assistance to Clinical Documentation Management Program (CDMP) with appropriate MS- DRG ... At Houston Methodist, the Coding Quality Auditor position is responsible for ensuring accuracy in...FUNCTIONS** + Responds promptly to internal and external customer coding/ DRG requests. Responds promptly to Business Office requests to… more
- AdventHealth (Altamonte Springs, FL)
- …you'll contribute:** The inpatient or outpatient coding team Corporate Quality Auditor (QA)/Educator supports the operations of the inpatient or outpatient coding ... to achieve industry best practice levels of performance. The Corporate Quality Auditor will adhere to AdventHealth Corporate Compliance standards, as well as rules… more
- R1 RCM (Boise, ID)
- …reducing operating costs and enhancing the patient experience. The Coding Denial Auditor will be responsible for reviewing denial coded cases for coding completeness ... and accuracy. This person will identify potential coding and DRG errors, researches appropriate guidelines to support recommended changes, and communicates the… more
- AdventHealth (Maitland, FL)
- **Coding Auditor Inpatient** **Work Hours/Shift:** + Full Time Remote **You Will Be Responsible For:** + Performs quality reviews on coded records to validate ICD-9, ... and overall accuracy of coding + Reviews, analyzes, and interprets clinical documentation, seeking clarification from the physician when discrepancies exist.… more
- Lucile Packard Children's Hospital Stanford (Palo Alto, CA)
- …the general nature, level and purpose of the job. The Senior Charge Capture Auditor works closely with clinical departments to ensure compliance with government, ... payer, and internal charge capture policies; provides education to the clinical departments. This position works with Med Assets software to manage clinical … more
- Northwell Health (Port Jefferson, NY)
- …substantiated by the documentation in the Medical Record. Job Responsibility 1.Leverages clinical expertise to identify and validate DRG code assignment. 2.Full ... codes on Medicare/non-Medicare charts for compliance to rules and conventions. 7.Communicates DRG changes and rationale to the coding and CDI staff. 8.Identifies… more
- Scottish Rite for Children (Dallas, TX)
- …to giving children back their childhood! Job Posting Title: Outpatient Clinical Documentation Improvement Specialist Location: Dallas - Hospital Additional Posting ... by HIM Leadership; acts as a resource to staff. + Provide clinical documentation integrity education and training to physicians, physician groups, and Advanced… more
- R1 RCM (Boise, ID)
- …+ Review and interpret medical records to appeal denied and underpaid claims. + Apply clinical judgment and knowledge for DRG downgrades performed because of a ... Clinical Validation Review by an insurer or third-party auditor . + Draft appeal letters that are well-written, logically structured, and persuasive, utilizing… more
- The Arora Group (Hampton, VA)
- …+ Have advanced knowledge of the International Classification of Diseases, Clinical Modification (ICD-CM); Healthcare Common Procedure Coding System (HCPCS); and ... last 10 years. Required experience must include Medical Severity-Diagnostic Related Group (MS- DRG ) assignment. A minimum of one year of performance in the specialty… more
- Brockton Hospital (Brockton, MA)
- …program requirements. Clearly communicate such requirements to management, clinical and operations staff. Conducts and coordinates compliance investigations ... issues. + Supports internal and external audits of HCPCS, CPT coding, DRG coding, and medical record reviews, using proven healthcare audit methodology, with… more