- Datavant (Lansing, MI)
- …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
- Deloitte (Detroit, MI)
- …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
- Trinity Health (Livonia, MI)
- …severity of illness, risk of mortality, clinical validity and proper DRG assignment. **ESSENTIAL FUNCTIONS** Knows, understands, incorporates, and demonstrates the ... system goals are met. Maintains current knowledge of the MS- DRG system, CCs/MCCs, impact on quality, risk of mortality,...direct reports perform clinical validation as part of the review process and remain current on CDI strategies. Maintains… more
- Molina Healthcare (Warren, MI)
- …fee for service, value based pricing, capitation, and bundled payments (APG, EAPG, APR- DRG , MS- DRG , etc.). Works with internal and external stakeholders to ... reimbursement team activities and troubleshooting. **Job Duties** + Research, review , and decipher state-specific Medicaid and Medicare reimbursement methodologies… more
- Trinity Health (Livonia, MI)
- …severity of illness, risk of mortality, clinical validity and proper DRG assignment. **ESSENTIAL FUNCTIONS** Knows, understands, incorporates and demonstrates the ... ensure positive outcomes. Demonstrates a thorough understanding of the MS- DRG system, CCs/MCCs, impact on quality and CMI as...direct reports perform clinical validation as part of the review process and remain current on CDI strategies. Uses… more
- Datavant (Lansing, MI)
- …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
- Datavant (Lansing, MI)
- …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
- Corewell Health (Caledonia, MI)
- …Related Groups ( DRG ) or All Patient Refined Diagnostic Related Groups (APR- DRG ) accuracy.The outpatient senior coder will review multiple service lines of ... Job Summary The inpatient senior coder will thoroughly review inpatient record accounts to assign correct ICD-10-CM diagnosis codes and ICD-10-PCS procedure codes… more
- Molina Healthcare (MI)
- …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 (Detroit, MI)
- …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