- Oracle (Tallahassee, FL)
- …of care, clinical validation) to lead the appeals initiative to review denied claims, create write-ups for appeals packets, identify trends/improvement opportunities ... Improvement experience. + Knowledge of medical and insurance terminology, MS- DRG , APR- DRG , CPT, ICD coding structures, and...payor rules and regulations. + 2-3 years of Utilization Review experience in a healthcare setting preferred; 1-2 years… more
- Datavant (Tallahassee, FL)
- …Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical necessity and necessity of continued stay ... should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and appeal writing for inpatient admission. Experience with clinical… more
- Molina Healthcare (Jacksonville, FL)
- …team and key stakeholder meetings (PowerPoint) * Coordinates and provides peer review of our quarterly national contract performance analysis by team members to ... reports and makes recommendations based on relevant findings. * Provides peer review of pricing configuration to ensure accuracy of financial modeling * Provides… more
- Molina Healthcare (Tampa, FL)
- …team and key stakeholder meetings (PowerPoint) + Coordinates and provides peer review of our quarterly national contract performance analysis by team members to ... reports and makes recommendations based on relevant findings. + Provides peer review of pricing configuration to ensure accuracy of financial modeling + Provides… more
- Datavant (Tallahassee, FL)
- …caregivers to ensure appropriate reimbursement and clinical severity for DRG -based payer patients. + Demonstrate understanding of complications, co-morbidities, ... risk of mortality, case mix index, secondary diagnoses, and procedure impact on DRG . + Improve coding specificity by educating physicians and caregivers on the… more
- HCA Healthcare (Ocala, FL)
- …Qualifications** As a work from home Inpatient Coding Specialist, you will review and evaluate hospital inpatient medical record documentation to assign, sequence, ... the appropriate ICD-10-CM and ICD-10- PCS codes. You will perform coding and/or code/ DRG validation across multiple entities. **What you will do in this role:** +… more
- Humana (Tallahassee, FL)
- …coding. Applies clinical and coding experience to conduct a clinical validation review of the inpatient medical record to validate billed diagnoses. Understands ... For example: ICU, CCU, PCU, med-surg/adult units or a minimum of 2 years DRG Inpatient auditing. NOTE: Inpatient experience does **not** refer to any other levels of… more
- Cognizant (Tallahassee, FL)
- …and **PCS** (Procedure Coding System) standards. . **Responsibilities** + Review clinical documentation to assign accurate **ICD-10-CM** and **ICD-10-PCS** codes. ... and **3M Encoder** systems. **Preferred Skills** + Advanced understanding of DRG reimbursement methodologies. + Prior experience in high-volume coding environments.… more
- Humana (Tallahassee, FL)
- …guidance where needed. Follows established guidelines/procedures. **KEY ACCOUNTABILITIES** + Review medical documentation, obtain additional information that may be ... timeframes when physician is available for peer to peer review , and forward to physician review companies...guidelines + Working knowledge of ICD-9 or ICD-10, HCPCS, DRG use + Experience with TRICARE contracts and/or the… more
- Datavant (Tallahassee, FL)
- …overall 95% coding accuracy rate and a 95% accuracy rate for MS- DRG assignments + Maintain site-specific productivity benchmarks + Foster professional communication ... medical facility. + Experience with significant level of coding quality review feedback + Experience in computerized encoding and abstracting software **What… more