- Mount Sinai Health System (New York, NY)
- **Job Description** The purpose of DRG validation is to confirm that diagnostic, procedural information, and the discharge status of the beneficiary, as coded and ... 10th Revision (ICD-10-CM and ICD-10-PCS) codes and the Diagnosis Related Groups ( DRG ). The CRM reviews the physician documentation for specificity, completeness and… more
- Kaleida Health (Buffalo, NY)
- **Director Clinical and DRG Denials** **Location:** Larkin Bldg @ Exchange Street Location of Job: US:NY:Buffalo Work Type: Full-Time **Shift:** Shift 1 Job ... Description **Summary:** The Director, Clinical & DRG Denials provides clinical leadership and administrative guidance to the Clinical Revenue Cycle department.… more
- Humana (Albany, NY)
- …expertise in Medicaid reimbursement methodologies rooted in complex grouping concepts (EAPG, APR- DRG , MS- DRG , etc). This role is within the Integrated Network ... for hospitals and facilities + Developing expertise in complex groupers (EAPG, APR- DRG , MS- DRG , etc) utilized in Medicaid reimbursement + Reviewing Medicaid… more
- Highmark Health (Albany, NY)
- …II code and modifier assignments, ICD diagnosis and procedure coding, DRG /APC structure according to regulatory requirements. Reports findings both verbally and ... systems, missed secondary diagnoses and procedures and ensures compliance with DRG /APC structure and regulatory requirements. Performs periodic claim form reviews to… more
- Elevance Health (Latham, NY)
- …conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group ( DRG ) paid claims. **How you will make an impact:** + Analyzes and audits ... 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
- Kaleida Health (Buffalo, NY)
- …an accurate reflection of the patient condition in the associated DRG assignments, case-mix index, documentation/coded quality metrics, and reimbursement. The CDS ... exhibits a sufficient knowledge of clinical documentation requirements, DRG assignment, and clinical conditions and/or procedures. They educate members of the… more
- WMCHealth (Valhalla, NY)
- …documentation clarification + Ensures that all factors necessary for assigning an accurate DRG are present, and that all diagnoses are ranked properly. + Makes ... Provides information and responds to inquiries regarding medical documentation and DRG 'S to hospital staff including Utilization and Quality Assurance staff, Patient… more
- Intermountain Health (Albany, NY)
- …risk of mortality, and quality of care + Performs audits including DRG (Diagnosis Related Groups), ICD-10 CM/PCS (Procedure Classification System), CPT, and PSI ... of medical terminology, medical acronyms, pharmacology, anatomy and physiology and ICD-10-CM/PCS, DRG , and APR- DRG classification systems. + Ability to complete… more
- Stony Brook University (Commack, NY)
- …Official Coding guidelines by specific chapter. + Provide education to the CDI staff on DRG Expert reviews. Identify surgical DRG 's versus Medicine DRG 's. + ... Provide education to the CDI staff on the use of all coding software, such as, Access HIM, 3M CRS and References and PwC SMART software. + Provide education to the CDI staff on coding guidance on an ongoing basis. + Review and respond to coding questions. +… more
- WMCHealth (Valhalla, NY)
- …including reimbursement formulas/calculations in accordance with payment methodology ( DRG , Medicare/Medicaid, Managed Care - Commercial, etc,). Validates payment ... Experience: 2-3 years of experience working with reimbursement methodologies ( DRG 's, managed care, medicare, etc.) for a managed care organization,… more