- Mount Sinai Health System (New York, NY)
- …of the DRG assignments flagged pre-billing. Determines if a secondary review is required to verify assignment of Patient Safety Indicators, HAC, Clinical ... **Job Description** The purpose of DRG validation is to confirm that diagnostic, procedural...Improvement,Sepsis and any other charts meeting criteria for secondary review . Initiates an MD query to clarify documentation in… more
- Banner Health (New York, NY)
- …identify possible opportunities for improvement of clinical documentation and accurate MS- DRG , Ambulatory Payment Classification (APC) or ICD-9 assignments on health ... and its impact on reimbursement under Medicare Severity Adjusted System (MS- DRG ), and Ambulatory Payment Classification (APC) or utilized operational systems… more
- WMCHealth (Valhalla, NY)
- …to the the coding leadership team. + Participates in mandated medical record review processes. + Using current ICD coding systems, assigns and records an accurate ... medical record. + Ensures that all factors necessary for assigning an accurate DRG are present, and that all diagnoses are ranked properly. + Makes appropriate… more
- Nuvance Health (Danbury, CT)
- …and maintain expertise in assessing inpatient medical necessity, utilization review and assignment of appropriate admission status assignment, care progression, ... providers, case managers, and other staff regarding appropriate utilization review processes, correct status assignment, and necessary clinical documentation to… more
- Catholic Health Services (Bethpage, NY)
- …Educate staff, physicians, patients, and families in the case management process. Review new admissions and continued stay patients to determine whether MCG criteria ... is met. Engage physicians to establish the optimal DRG , length of stay and expected date of discharge....for reviews in a timely fashion to avoid denials. Review records and collaborate with the interdisciplinary team to… more
- Mount Sinai Health System (New York, NY)
- …medicine. Healing made personal. **_Roles & Responsibilities:_** Responsible for the review and coding of complex inpatient and/or ambulatory surgery records ... preferred. Experience: Proficiency in the use of automated coding and DRG /AOC grouping software. **_Strength Through Diversity_** The Mount Sinai Health System… more
- Molina Healthcare (New York, NY)
- …experience. **Required Experience** * 7 years experience in healthcare claims review and/or member appeals and grievance processing/resolution, including 2 years in ... Loss, Surgery, Anesthesia, high dollar complicated claims, COB and DRG /RCC pricing). 2 years supervisory/management experience with appeals/grievance processing… more
- New York eHealth Collaborative (New York, NY)
- …interoperability knowledge across the NYeC team. + Lead enterprise Architecture Review Board (ARB). + Knowledgeable about industry trends, experiences and approaches ... in the use of clinical terminology such as LOINC, ICD9, SNOMED/CT, HCPCS, DRG . + Experience and knowledge of healthcare interoperability preferred. Such as HL7, CDA,… more
- Mount Sinai Health System (New York, NY)
- …FT Days M-F 8AM-4PM** The Coding Specialist III is responsible for the review and coding of complex inpatient and/or ambulatory surgery records utilizing ICD-10-CM ... care hospital. Proficiency in the use of automated coding and DRG /APC grouping software. **Licensing and Certification Requirements (if applicable)** Name: Certified… more