- 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
- 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
- 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
- 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
- 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
- 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
- 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
- BronxCare Health System (Bronx, NY)
- Overview Review clinical documentation and diagnostic results as appropriate to extract data and apply appropriate ICD-10-CM and ICD 10-PCS codes for billing, ... and other required data into the clinical information system for accurate DRG assignments. Identifies non-payment conditions (HAC) and when required, report through… more