- Elevance Health (Atlanta, GA)
- …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 (Atlanta, GA)
- …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
- Emory Healthcare/Emory University (Atlanta, GA)
- …to educate physicians, nursing, and other clinical staff to improve documentation. + Review ?s DRG Reassignment letters and assists in formulating Appeal letters ... leadership programs and more! **Description** We are seeking an experienced **Inpatient DRG Coding Auditor** to extract data from patient encounters ensuring the… more
- Elevance Health (Atlanta, GA)
- …clinical documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group ( DRG ) paid claims. **How you will ... **Title:** Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS- DRG , AP- DRG and APR- DRG ) **Virtual:** This role enables associates to work… more
- Datavant (Atlanta, GA)
- …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 (GA)
- …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
- Molina Healthcare (Macon, GA)
- …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 (GA)
- …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 (Atlanta, GA)
- …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
- Oracle (Atlanta, GA)
- …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