• Nurse Reviewer

    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
    Zelis (09/05/24)
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  • Diagnosis Related Group Auditor

    Hackensack Meridian Health (Hackensack, NJ)
    …Health Information Management (HIM) education. + Minimum of 5 years progressive coding review in ICD-10-CM and DRG methodologies. + Knowledge of POA/HAC, PSI ... serve as a leader of positive change. The **Diagnosis Related Group ( DRG ) Auditor** is responsible for auditing clinical documentation that supports code assignment… more
    Hackensack Meridian Health (09/06/24)
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  • Clinical Reimbursement Manager- Billing,…

    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
    Mount Sinai Health System (08/21/24)
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  • Diagnosis Related Group Clinical Validation…

    Elevance Health (Morristown, 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
    Elevance Health (09/17/24)
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  • Inpatient Facility Coder Quality Associate Remote

    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
    Banner Health (08/30/24)
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  • Coding Quality Auditor

    Hackensack Meridian Health (Hackensack, NJ)
    …Meridian** **_Health_** includes: + Reviews Diagnosis Related Group ( DRG ) assignment for selected Medicare/Medicaid inpatients, Hospital-acquired condition (HAC), ... + Provides guidance on any changes made during their review to the Inpatient Coders by furnishing input as...and rationale (if needed) in 3M as needed for DRG mismatches on Clinical Documentation Improvement (CDI) reviewed cases.… more
    Hackensack Meridian Health (08/09/24)
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  • Inpatient Coder-Evening

    Hackensack Meridian Health (Hackensack, NJ)
    …and ICD-10-Procedure Coding System (PCS) codes creating diagnosis-related group ( DRG ) assignments. Abstracts pertinent information from patient records. + Sequence ... the diagnosis and procedures using coding guidelines and optimizing the DRG as applicable. + Addressing all edits, including but not limited to nosology, Exihauser,… more
    Hackensack Meridian Health (07/18/24)
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  • Inpatient Coding/Quality Educator

    Hackensack Meridian Health (Hackensack, NJ)
    …Morbidity, etc.) and clinical evidence to support Diagnosis-related group ( DRG ), principal diagnosis, and secondary diagnoses assignments. Enables accurate ... a discrepancy in the Clinical Documentation Specialist and Coder DRG and coaching of the CDMP Team on PSI....development and evaluation of staff competencies. + RAC - Review and distribute letters to appropriate departments, ie **Qualifications**… more
    Hackensack Meridian Health (09/27/24)
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  • Supervisor, Revenue Cycle & Reconciliation, North

    Hackensack Meridian Health (Hackensack, NJ)
    …Ensure modification to Reimbursement Contract Management system is working efficiently. + Ensure DRG in the EPIC system are upgraded or loaded to current versions ... timely. + Ensure that established functional standard of productivity is met. Review staff performance in relationship to the standard established. Responsible for… more
    Hackensack Meridian Health (09/10/24)
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  • Director, Appeals & Grievances

    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
    Molina Healthcare (09/28/24)
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  • Inpatient/Outpatient Coding Specialist I-MSH-…

    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
    Mount Sinai Health System (09/28/24)
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  • Senior Architect, Data Integration…

    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
    New York eHealth Collaborative (08/22/24)
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  • Inpatient/Outpatient Certified Coding Spec. III…

    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
    Mount Sinai Health System (07/12/24)
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  • Claims Auditor

    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
    Centers Plan for Healthy Living (09/09/24)
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  • Business Analyst II

    Elevance Health (Woodbridge, NJ)
    …as needed. + Submit enhancement request for database updates. + Ensures proper review of the Forager Pipeline and Analyst reports. + Commit to deliverables and ... system design and testing. + Perform data mining utilizing CPT, HCPCS, DRG , ICD-9, ICD-10, etc., to identify recovery opportunities. + Validate overpayments,… more
    Elevance Health (09/26/24)
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