- Christus Health (Woodworth, LA)
- …and co-morbidities are a complete reflection of the patient's clinical status and care. Review final DRG and compare with clinical data gathered to ensure the ... of clinical severity and services rendered to patients with a DRG based payer (Medicare, Medicaid). Supports timely, accurate and complete documentation… more
- Christus Health (Beaumont, TX)
- …RN will provide support and expertise through comprehensive assessment and review of inpatient medical records. The clinical documentation RN will facilitate ... accurate DRG assignment and obtain appropriate documentation through extensive interaction...finalize diagnosis Consistently meets established productivity targets for record review Designs and implements in collaboration with physician leadership… more
- Christus Health (San Antonio, TX)
- …for PAN referrals. Proactively uses 3M report which assigns working MS/APR DRG in MIDAS daily, and queries, communicates and collaborates with nursing, physicians, ... Proactively refers cases to physician adviser for P2P, medical necessity review , and denail avoidance. Demonstrates and maintains current knowledge of regulatory… more
- Stanford Health Care (Palo Alto, CA)
- …development and reporting of findings. + Prepares written reports of review findings and recommendations and presents to management and maintains monitoring ... substandard documentation and inaccurate procedural billing. + Performs concurrent review of hospital bills to document non-billed, underbilled, and overbilled… more
- Zelis (FL)
- …personal interests that shape who you are. Position Overview The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment ... and post pay comprehensive inpatient DRG reviews based on industry standard inpatient coding guidelines...Clinic and client specific coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest… more
- Zelis (NJ)
- …is responsible for conducting post-service, pre-payment and post pay comprehensive inpatient DRG Quality Assurance reviews in an effort to increase the savings ... achieved for Zelis clients. Conduct reviews on inpatient DRG claims as they compare with medical records utilizing ICD-10 Official Coding Guidelines, AHA Coding… more
- Excellus BlueCross BlueShield (Rochester, NY)
- Job Description: Summary: The Payment Integrity DRG Coding & Clinical Validation Analyst position has an extensive background in acute facility-based clinical ... has a high level of understanding of the current MS- DRG , and APR- DRG payment systems. This position...and claims processing platform. . Manages case volumes and review /audit schedules, prioritizing case load as assigned by Management.… more
- Elevance Health (Grand Prairie, TX)
- …clinical reviews of medical records and other documentation to evaluate issues of coding and DRG assignment accuracy. Specializes in review of DRG coding via ... Extraordinary Impact.** **Title** : Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS- DRG , AP- DRG and APR- DRG ) **Virtual: ** _ _ This role… more
- Elevance Health (Roanoke, VA)
- …of the Company, for all lines of business, and its clients. Specializes in review of DRG coding via medical record and attending physician's statement provided ... ** DRG Coding Auditor Principal** **_Virtual: _** _ _...to recover, eliminate and prevent unnecessary medical-expense spending. The ** DRG Coding Auditor Principal** is responsible for auditing inpatient… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …to educate physicians, nursing, and other clinical staff to improve documentation. + Review ?s DRG Reassignment letters and assists in formulating Appeal letters ... leadership programs and more! **Description** We are seeking an experienced **Inpatient DRG Coding Auditor** to extract data from patient encounters ensuring the… more
- Hartford HealthCare (Farmington, CT)
- …is responsible for reviewing, analyzing and appealing denials related to DRG (Diagnostic Related Group) downgrades. This role involves validating the coding ... address payer concerns. Key responsibilities include timely investigation of DRG downgrades, submitting appeals, coordinating follow-up actions and ensuring… more
- Insight Global (South Jordan, UT)
- Job Description Insight Global is seeking a DRG Validation Auditor for one of our clients to sit 100% remote. The work authorization is not specified and the salary ... a high level of understanding of reimbursement guidelines specifically an understanding of the MS- DRG , AP- DRG , and APR- DRG payment systems. This position is… more
- Elevance Health (Seattle, WA)
- …clinical documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group ( DRG ) paid claims. **How you will ... **Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS- DRG , AP- DRG and APR- DRG )** **Virtual:** This role enables associates to work virtually… more
- University of Michigan (Ann Arbor, MI)
- …procedures. + Review and provide documentation to support appeals for DRG denials from third-party payers to prevent financial loss. + Implement corrective ... DRG COMPLIANCE AUDITOR (DCA) **Early Site Maintenance** We...postings can not be submitted. Apply Now **Job Summary** Review and check certain inpatient records to make sure… more
- HCA Healthcare (Nashville, TN)
- …personal growth, we encourage you to apply for our Coding Quality Audit Reviewer opening. We promptly review all applications. Highly qualified candidates will ... We care like family! Jump-start your career as a DRG Validation Auditor today with Parallon. **Benefits** Parallon offers...Come join our team as a Coding Quality Audit Reviewer . We care for our community! Just last year,… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The DRG Denials Auditor conducts hospital inpatient DRG denial audits for both RAC and non-RAC accounts, reviewing patient records for accuracy ... in ICD-10-CM/PCS coding, DRG assignments, and supporting clinical documentation. This includes evaluating...via scanned, electronic and hybrid medical records. Based on review findings, writes appeal letters to include supporting documentation.… more
- WMCHealth (Valhalla, NY)
- …in working with multiple computer applications and EMR systems. Responsibilities: + Review diagnostic, procedural and DRG assignments for validity and accuracy. ... DRG Validator Company: NorthEast Provider Solutions Inc. City/State:...(https://pm.healthcaresource.com/cs/wmc1/#/preApply/31147) Internal Applicant link Job Details: Job Summary: The DRG Validator will be responsible for coding reviews for… more
- UTMB Health (Galveston, TX)
- …for proper coding of all pertinent diagnoses and procedures and to provide optimal DRG assignment after thorough review of medical record and analysis of ... Senior DRG Coder - RCO Coding **Galveston, Texas, United...or equivalent and three years of experience. The Sr. DRG coder must be proficient in inpatient coding with… more
- Insight Global (Plano, TX)
- Job Description Insight Global is seeking experienced DRG Auditors to join a remote healthcare organization. The DRG Revenue Integrity Auditor will perform ... Diagnostic Related Group ( DRG ) validation and quality audits on inpatient charts to ensure accurate coding and compliance with federal regulations. This is a remote… more
- SSM Health (IL)
- …the principal diagnosis, pertinent secondary diagnoses, and procedures for accurate diagnosis review group ( DRG ) assignment, risk of mortality (ROM), and ... reflection of the patient condition in the associated Diagnosis Related Group ( DRG ) assignments, case-mix index, severity of illness (SOI), and risk of mortality… more
