- Elevance Health (Tampa, FL)
- …Possibilities. Make an Extraordinary Impact.** **Title** : Diagnosis Related Group Clinical Validation Auditor (CDI, MS- DRG , AP- DRG and APR- DRG ... and Experiences** : + BA/BS preferred. + Experience with vendor based Diagnosis - Related Group ( DRG ) Coding/Clinical Validation Audit setting or… more
- Elevance Health (FL)
- ** Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS- DRG , AP- DRG and APR- DRG )** **Virtual:** This role enables associates to work ... supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group ( DRG ) paid claims. **How you will make… more
- Molina Healthcare (St. Petersburg, FL)
- …offset to include, eligibility, coordination of benefits (COB), standard of care (SOC) and diagnosis - related group ( DRG ) requests. * Enters and updates ... departmental Standard Operating Procedures (SOPs). * Responds to provider correspondence related to claims recovery requests and provider remittances where recovery… more
- Molina Healthcare (Tampa, FL)
- …and reports quality of care issues. + Assists with complex claim review including diagnosis - related group ( DRG ) validation, itemized bill review, ... appropriate level of care, inpatient readmission, and any opportunities identified by the payment integrity analytical team; makes decisions and recommendations pertinent to clinical experience. + Prepares and presents cases representing Molina, along with the… more
- Houston Methodist (FL)
- …position is responsible for ensuring accuracy in code assignment of diagnosis and procedure to outpatient and/or inpatient encounters based upon documentation ... Takes initiative to assist others and shares knowledge with the coding group and business partners on official coding guidelines. **SERVICE ESSENTIAL FUNCTIONS** +… more