- Zelis (FL)
- …personal interests that shape who you are. 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
- Elevance Health (Tampa, FL)
- …clinical reviews of medical records and other documentation to evaluate issues of coding and DRG assignment accuracy. Specializes in review of DRG coding via ... Extraordinary Impact.** **Title** : Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS- DRG , AP- DRG and APR- DRG ) **Virtual: ** _ _ This role… more
- Elevance Health (Lake Mary, FL)
- …of the Company, for all lines of business, and its clients. Specializes in review of DRG coding via medical record and attending physician's statement provided ... ** DRG Coding Auditor Principal** **_Virtual: _** _ _...to recover, eliminate and prevent unnecessary medical-expense spending. The ** DRG Coding Auditor Principal** is responsible for auditing inpatient… more
- Elevance Health (FL)
- …clinical documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group ( DRG ) paid claims. **How you will ... **Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS- DRG , AP- DRG and APR- DRG )** **Virtual:** This role enables associates to work virtually… more
- Datavant (Tallahassee, FL)
- …the future of healthcare from your own workspace! Seeking Inpatient Auditor proficient in MS- DRG and APR- DRG **What You Will Do:** + Performs Inpatient Facility ... reviews, using appropriate assignment of codes and other coding-related elements using MS DRG or APR DRGs. + Provides rich and concise rationale explaining the… more
- Houston Methodist (FL)
- …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
- Deloitte (Tampa, FL)
- …nurse, physician, physician assistant, case manager, clinical documentation specialist, utilization review , informatics RN, Quality, DRG Validation and health IT ... regarding clinical documentation standards and clinical indicators which drive reimbursement, MS- DRG , APR- DRG , PSIs, HACs, POA, Vizient, Elixhauser, public… more
- Molina Healthcare (Tampa, FL)
- …Identifies and reports quality of care issues. + Assists with complex claim review including diagnosis-related group ( DRG ) validation, itemized bill review , ... **Job Description** **Job Summary** The Medical Review Nurse provides support for medical claim and...Nurse provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and… more
- Houston Methodist (FL)
- …rules and regulatory body guidelines. This position performs data quality review to ensure data integrity, coding accuracy, and revenue preservation. Additional ... duties include participating in quality review and performance improvement projects throughout the department and/or facility. **PEOPLE ESSENTIAL FUNCTIONS** +… more
- Datavant (Tallahassee, FL)
- …on medical records, utilizing ICD-10-CM, CPT, and appropriate coding references for accurate DRG and APC assignment. + Review non-CC/MCC records to assess proper ... for review by the facility or CCS HIM director. + Review disagreements on APC/ DRG changes with the appropriate manager. + Prepare the final reports for the… more