- 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)
- **Job Description** The DRG Appeals Analyst - CDI Liaison is responsible for analyzing medical records, claims data, and coding on all diagnoses and procedures (both ... and surgical) to assure properly assigned diagnostic related grouping ( DRG ) for purposes of appeal. This individual assures that...assigned by the client was properly assigned based upon review of the medical documentation and application of the… more
- 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
- 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
- RWJBarnabas Health (Oceanport, NJ)
- …responsible for ensuring accuracy and integrity of ICD-10-CM/PCS coding and DRG assignment for inpatient encounters for other payers (not Medicare/Managed Medicare). ... and integrity of ICD-10-CM/PCS, CPT coding when applicable and DRG assignment for adherence to Federal and State Regulations...a team with other Quality Officers to ensure SMART review goals are met for all RWJBarnabas facilities. +… more
- Hackensack Meridian Health (Neptune, NJ)
- …admissions and observations as specified by the facility's Utilization Management/ Review Committee for documentation completeness and compliance with patient status. ... the medical screening process by documenting appropriateness of patient admission, working DRG & LOS information on worksheet and computer system as appropriate. +… more
- Zelis (Morristown, NJ)
- Position Overview: The Bill Review Operations Analyst will provide daily operational support to the Expert Claims Review team, including the itemized bill ... review , clinical chart review , and document retrieval teams. Responsibilities include reporting, claims management, analysis, client savings identification,… 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
- 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
- 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 (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
- 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
- Catholic Health Services (Rockville Centre, NY)
- …required. CCDS certification required within 2 years of hire date Skills: Chart review skills with ICD 10CM.PCS experience preferred. Experience: Minimum of 5 years ... and procedures where inadequate or conflicting documentation exists. Verifies DRG assignment with medical record documentation and consults with...level of service rendered to all patients with a DRG based payor. Demonstrates knowledge of DRG … 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
- Northwell Health (Garden City, NY)
- …the Medical Record. Job Responsibility 1.Leverages clinical expertise to identify and validate DRG code assignment. 2.Full review of CDI suggested code changes ... State regulations. 5.Applies coding rules and regulations to the validation review process. 6.Reviews codes on Medicare/non-Medicare charts for compliance to rules… more
- BronxCare Health System (Bronx, NY)
- …levels of care. - Maintain knowledge of Managed Care requirements, DRG , insurance benefits, IPRO regulations and nationally recognized medical necessity criteria. ... findings in cooperation with other health care professionals. Preparation of Patient Review Instrument (PRI) Screen, Case form, AIDS chronic care package required.… more
- Catholic Health Services (Rockville Centre, NY)
- …is received for the level of service rendered to all patients with a DRG based payor. Ensures the accuracy and completeness of clinical information used for ... received for the level of service rendered to all patients with a DRG based payor. Demonstrates proficiency in clinical documentation requirements for the accurate… more
- 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
- BronxCare Health System (Bronx, NY)
- …of illness/intensity of service guidelines. The CDS will work with hospital top DRG 's to insure that documentation is optimal and meets coding clinic guidelines in ... improvements and educational outcomes. Responsibilities + Provides concurrent and retrospective review of the clinical documentation in the medical record; review… more
- 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