- Zelis (Morristown, NJ)
- Position Overview: The Nurse Reviewer is primarily responsible for conducting post-service, pre or post payment in-depth claim reviews based on accepted medical ... billing and coding rules, plan policy exclusions, and payment errors/overpayments. Conduct review of facility and outpatient bills as it compares with medical… more
- 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
- Elevance Health (Woodbridge, NJ)
- …clinical documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group ( DRG ) paid claims. **How you will ... improvement, and a minimum of 5 years of experience working with ICD-9/10CM, MS- DRG , AP- DRG and APR- DRG ; or any combination of education and experience,… 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
- Mount Sinai Health System (Brooklyn, NY)
- …Thorough knowledge of Medical Terminology, ICD-9-CM and ICD-10 coding, as well as DRG logic and CRT coding. Thorough knowledge of current coding guidelines. + ... Coder - THIS IS AN ON-SITE POSITION** 1. Thoroughly review , analyze, and interpret the entire medical record (electronic...software to assign diagnosis and procedure codes and respective DRG . Utilize the clinical analyzer to assist in refining… 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
- 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
- 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
- Centers Plan for Healthy Living (Staten Island, NY)
- …and identifying any deficiencies. + Prepare summaries for management of quality review results, including basic analysis of identified trends. + Analyzes audit ... for workflow enhancements. + Evaluates Prospective Payment System (PPS) (eg APC, DRG , etc.) grouping and pricing information. + Meets individual and departmental… more