- Elevance Health (Indianapolis, IN)
- ** DRG (DIAGNOSTIC RELATED GROUP) CODING AUDITOR ** **Location** : This position will work a hybrid model (remote and office). The ideal candidate will live within ... our Elevance Health PulsePoint locations. The **DIAGNOSTIC RELATED GROUP CODING AUDITOR ** is responsible for auditing inpatient medical records and generating high… more
- R1 RCM (Detroit, MI)
- …satisfaction and improves financial performance. As the Inpatient Coding and Documentation Auditor II, your primary role will be auditing inpatient cases for ... DRG validation and/or documentation improvement. This consists of reviewing...accounts. Opportunity for growth includes a client facing Lead Auditor role and an internally facing Mentor role. Every… more
- R1 RCM (Boise, ID)
- As the Inpatient Coding and Documentation Auditor I, your primary role will be auditing inpatient cases for DRG validation and/or documentation improvement. This ... systems to validate the accounts. Opportunity for growth includes a client facing Lead Auditor role and an internally facing Mentor role. Everyday in this role you… more
- Hackensack Meridian Health (Hackensack, NJ)
- …this includes compliance with the Conditions of Participation for CMS. The DRG auditor is responsible for ensuring coding accuracy, coding consistency ... and serve as a leader of positive change. The **Diagnosis Related Group ( DRG ) Auditor ** is responsible for auditing clinical documentation that supports code… more
- The Mount Sinai Health System (New York, NY)
- **JOB DESCRIPTION** The DRG Appeals Analyst - CDI Liaison is responsible for analyzing medical records, claims data, and coding on all diagnoses and procedures (both ... medical and surgical) to assure properly assigned diagnostic related grouping ( DRG ) for purposes of appeal. This individual assures that the most accurate and… more
- Elevance Health (Columbus, OH)
- **Diagnosis Related Group Clinical Validation Auditor ** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within ... one of our PulsePoint locations. The **Diagnosis Related Group Clinical Validation Auditor ** is responsible for auditing inpatient medical records to ensure clinical… more
- Hackensack Meridian Health (Hackensack, NJ)
- …and serve as a leader of positive change. The **Coding Quality Auditor ** is responsible for monitoring compliance with applicable clinical documentation to support ... **Responsibilities** A day in the life of an **Coding Quality Auditor ** at **Hackensack Meridian** **_Health_** includes: + Reviews Diagnosis Related Group… more
- Medical Mutual of Ohio (OH)
- …,_** **_and/or_** **_hospital bill auditing experience._** **Responsibilities** **Clinical Auditor ** + **Audits outpatient, inpatient and professional claims from ... payment recovery staff.** + **Performs other duties as assigned.** **Sr Clinical Auditor ** + **Audits outpatient, inpatient and professional claims from a clinical… more
- Houston Methodist (Austin, TX)
- At Houston Methodist, the Coding Quality Auditor position is responsible for ensuring accuracy in code assignment of diagnosis and procedure to outpatient and/or ... **SERVICE ESSENTIAL FUNCTIONS** + Responds promptly to internal and external customer coding/ DRG requests. Responds promptly to Business Office requests to code or… more
- AdventHealth (Tampa, FL)
- …Stroke Center. **The role you'll contribute:** The Inpatient Coding Quality Auditor , under general supervision of the Inpatient Operations Manager, is responsible ... the daily auditing of records. The Inpatient Coding Quality Auditor works in collaboration with the Manager to ensure...you'll bring to the team:** . Reviews records for DRG and overall coding accuracy retrospectively and concurrently as… more
- Nuvance Health (Danbury, CT)
- …(SACO) Physician Audit & Billing, the Senior Inpatient Professional Auditor providesHospital Inpatient and Outpatient coding, billing, and documentation auditing ... to ensure compliance with all Federal and State guidelines. Ensure correct DRG and APC assignments for Institutional claims. 2. Maintains confidentiality of… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Outpatient Coder Auditor Trainee reviews and analyzes ... Specialists (CDS) or Computer Assisted Coding (CAC) software. The Outpatient Coder Auditor Trainee finalizes the coding and abstracting of the medical record upon… more
- Centers Plan for Healthy Living (Staten Island, NY)
- Claims Auditor 75 Vanderbilt Ave, Staten Island, NY 10304, USA Req #1153 Monday, September 9, 2024 Centers Plan for Healthy Living's goal is to create the ultimate ... for workflow enhancements. + Evaluates Prospective Payment System (PPS) (eg APC, DRG , etc.) grouping and pricing information. + Meets individual and departmental… more
- Lucile Packard Children's Hospital Stanford (Palo Alto, CA)
- …general nature, level and purpose of the job. The Senior Charge Capture Auditor works closely with clinical departments to ensure compliance with government, payer, ... third-party requirements, revenue codes assignments, CPT, HCPCS and ICD-9. + DRG and APC classification systems; medical terminology; billing and reimbursement… more
- Northwell Health (Garden City, NY)
- …Record. Job Responsibility 1.Leverages clinical expertise to identify and validate DRG code assignment. 2.Full review of CDI suggested code changes 3.Demonstrates ... 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
- Kepro (Charleston, WV)
- …to facilitate payment for received services. + Identify medical claims meeting CPT/ DRG audit criteria and submits the necessary billing data and healthcare records ... to the third-party auditor . + Serve as liaison between the internal and external partners. + Investigate and resolve or report provider problems, and identify and… more
- Brockton Hospital (Brockton, MA)
- …issues. + Supports internal and external audits of HCPCS, CPT coding, DRG coding, and medical record reviews, using proven healthcare audit methodology, with ... government payers, including Medicare and Medicaid. Collaborate with SHC's Healthcare's Compliance Auditor to meet audit plan objectives. + Works with SHC management… more
- R1 RCM (Chicago, IL)
- …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 ICD-9/10 CM & PCS, CPT, HCPCS, NCCI guidance. +… more
- MD Anderson Cancer Center (Houston, TX)
- …of institutional coding policies and procedures; maintains knowledge of ICD-10-CM, PCS, DRG , SOI, ROM and CPT-4 coding guidelines according to CMS, AMA, AHA ... other departmental users 14. Ability to cover for other trainer(s) and/or auditor (s) 15. All other assigned duties **Working Conditions** This position requires:… more
- University of Rochester (Rochester, NY)
- …with project management preferred. + Prior experience with APG, APC, and/or DRG coding methodologies preferred. + Prior experience with professional billing in ... (CPC), Certified Professional Biller (CPB) or Certified Professional Medical Auditor (CPMA), Certified Outpatient Coder (COC), or Certified Professional Compliance… more