- HSS (New York, NY)
- …committed to our Mission, you too can be part of our transformation across the enterprise. DRG Reviewer Full-Time The DRG Reviewer reports to the ... Director of Coding, HIM (Health Information Management). The DRG Reviewer oversees DRG accuracy....+ Monitors coding and documentation accuracy. + Conducts retrospective review of the medical record to increase accuracy, clarity,… more
- Zelis (St. Petersburg, FL)
- Job Description Position Overview: The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay comprehensive ... inpatient DRG reviews based on industry standard inpatient coding guidelines...Clinic and client specific coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest… more
- HCA Healthcare (Nashville, TN)
- …environment where diversity and inclusion thrive? Submit your application for our Coding Quality Review DRG Specialist opening with Work from Home today and find ... Eligibility for benefits may vary by location._** We are seeking a Coding Quality Review DRG Specialist for our team to ensure that we continue to provide all… more
- Zelis (Plano, TX)
- Position Overview : The Manager, DRG Validation of the Expert Claims Review (ECR) department is responsible for daily operations and team management of the ... DRG product. The Manager, DRG Validation will be primarily responsible for the oversight of DRG validation reviews to ensure accurate and compliant coding… more
- Kaleida Health (Buffalo, NY)
- …and insurance / managed care practices including but not limited to: utilization review , RAC, MAC, Q10, clinical and DRG denial management required. Reg ... - Clinical Revenue Cycle Admin **Job Description:** The Director, Clinical & DRG Denials provides clinical leadership and administrative guidance to the Clinical… more
- UTMB Health (Galveston, TX)
- …for proper coding of all pertinent diagnoses and procedures and to provide optimal DRG assignment after thorough review of medical record and analysis of ... (Remote) Senior DRG Coder - Revenue Cycle Coding **Galveston, Texas,...or equivalent and three years of experience. The Sr. DRG coder must be proficient in inpatient coding with… more
- The Mount Sinai Health System (New York, NY)
- Maintains responsibility for coding/ DRG validation review , DRG PRO activities and assurance of optimal reimbursement. Oversees compliance with coding ... standards and regulations **Strength Through Diversity** The Mount Sinai Health System believes that diversity, equity, and inclusion are key drivers for excellence. We share a common devotion to delivering exceptional patient care. When you join us, you… more
- Vanderbilt University Medical Center (Nashville, TN)
- …of process improvements. * Performs pre and post-bill reviews, qualitative review and prospective third party payor reviews based on identified issues. ... Performs prebill reviews and education for new coders. * Performs data analysis of the audit program ,findings, and other source data, to identify trends and patterns. Creates detailed reports based on audit findings and facilitates change processes. * The… more
- UPMC (Pittsburgh, PA)
- **UPMC Health Plan is looking for a Senior Manager, Clinical and Coding Review to join the Quality Assurance team!** Directs and coordinates activities of workers ... in audit activities related to diagnosis, CPT/HCPC and HCC. Creates and implements review processes to address identified new risks. Responsible for the creation and… 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
- Hartford HealthCare (Farmington, CT)
- …alpha numeric diagnosis/procedure codes and Medicare Severity Diagnosis Related Groups (MS- DRG ). Data is classified for internal and external statistical reporting, ... and/or encoder, coding manuals and other reference material. 3. Reviews DRG assigned to each record. Enters coded/abstracted information into software, analyzes… more
- Hartford HealthCare (Newington, CT)
- …alpha numeric diagnosis/procedure codes and Medicare Severity Diagnosis Related Groups (MS- DRG ). Data is classified for internal and external statistical reporting, ... and/or encoder, coding manuals and other reference material. 3. Reviews DRG assigned to each record. Enters coded/abstracted information into software, analyzes… more
- Hackensack Meridian Health (Hackensack, 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
- Hackensack Meridian Health (Hackensack, NJ)
- …admissions and observations as specified by the facility's Utilization Management/ Review Committee for documentation completeness and compliance with patient status. ... in medical screening process by documenting appropriateness of patient admission, working DRG & LOS information on worksheet and computer system as appropriate. +… more
- RWJBarnabas Health (Oceanport, NJ)
- …is responsible for ensuring accuracy and integrity of ICD-10-CM/PCS coding and DRG assignment for inpatient Medicare encounters. This requires critical thinking and ... 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
- Trinity Health (Fort Lauderdale, FL)
- …clinical documentation specialist reviews the clinical record for accuracy related to the MS- DRG or the APR DRG , co-morbidities and complications and has ... toward the integrity of clinical documentation through the roles of reviewer , educator and consultant. Facilitates the overall quality, completeness, accuracy and… more
- Essentia Health (Duluth, MN)
- …documentation and assigning ICD-10-CM diagnosis, PCS procedure codes, and the DRG to ensure proper reimbursement for complex inpatient accounts. Requires extensive ... knowledge and understanding of ICD-10-CM/PCS coding guidelines, MS- DRG and APR- DRG reimbursement systems, medical terminology, and disease processes. Works… more
- Marshfield Clinic (Ladysmith, WI)
- …Uniform Hospital Discharge Data Set (UHDDS) and assignment of the appropriate MS- DRG (Medicare Severity-Diagnosis Related Group) or APR- DRG (All Patients Refined ... co-morbidities and complications, secondary conditions, surgical procedures and/or other procedures. + MS- DRG /APR- DRG + Present on admission indicators + HAC… more
- Houston Methodist (Houston, TX)
- …of clinical documentation. This position analyzes medical records for DRG 's, complications, and comorbidities; identifies trends; and notes observations and ... and follows up as necessary. Tracks responses and trends completion of DRG /Documentation worksheets as pertinent to scope of department. + Conducts follow-up reviews… more
- Zelis (St. Petersburg, FL)
- …our ECR product umbrella. This includes Itemized Bill Review , Clinical Chart Review , Dialysis Savings Solution and DRG Validation solutions. In this role, ... Position Overview At Zelis, t he Business Analyst - Expert Claims Review (ECR) is ultimately responsible for enabling high quality user stories under… more