- Mount Sinai Health System (New York, NY)
- …of the DRG assignments flagged pre-billing. Determines if a secondary review is required to verify assignment of Patient Safety Indicators, HAC, Clinical ... **Job Description** The purpose of DRG validation is to confirm that diagnostic, procedural...Improvement,Sepsis and any other charts meeting criteria for secondary review . Initiates an MD query to clarify documentation in… more
- Kaleida Health (Buffalo, NY)
- …and insurance / managed care practices including but not limited to: utilization review , RAC, MAC, Q10, clinical and DRG denial management required. **Working ... **Director Clinical and DRG Denials** **Location:** Larkin Bldg @ Exchange Street...Shift 1 Job Description **Summary:** The Director, Clinical & DRG Denials provides clinical leadership and administrative guidance to… more
- Centene Corporation (New York, NY)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for all ... requiring authorization. Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care… more
- Molina Healthcare (Yonkers, NY)
- …+ Identifies and reports quality of care issues. + Assists with Complex Claim review including DRG Validation, Itemized Bill Review , Appropriate Level of ... DESCRIPTION** **Job Summary** Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level… more
- Kaleida Health (Buffalo, NY)
- …Management, Quality Department and ancillary staff to perform concurrent analytical review of clinical documentation and coding data.The CDS facilitates obtaining ... an accurate reflection of the patient condition in the associated DRG assignments, case-mix index, documentation/coded quality metrics, and reimbursement. The CDS… more
- Elevance Health (Latham, NY)
- …clinical documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group ( DRG ) paid claims. **How you will ... 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
- Intermountain Health (Albany, NY)
- …Integrity (CDI) Registered Nurses (RN) and Intermountain Physician Advisors to review complex facility encounters and assign International Classification of Diseases ... ICD-10 and Diagnosis Related Groups ( DRG ) codes for claims concurrently while a patient is...reviews while patients are hospitalized. It aids in the review of quality measures including Patient Safety Indicators and… 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. + ... staff on coding guidance on an ongoing basis. + Review and respond to coding questions. + Work in...or for a maximum of 90 days. An initial review of all applicants will occur two weeks from… more
- Intermountain Health (Albany, NY)
- …all payer and regulatory denials and downgrades and provides in-depth coding review , audit findings, and appeal strategies. + Develops and implements training plans ... risk of mortality, and quality of care + Performs audits including DRG (Diagnosis Related Groups), ICD-10 CM/PCS (Procedure Classification System), CPT, and PSI… more
- WMCHealth (Valhalla, NY)
- …to the the coding leadership team. + Participates in mandated medical record review processes. + Using current ICD10 CM/PCS coding systems, assigns and records an ... documentation clarification + Ensures that all factors necessary for assigning an accurate DRG are present, and that all diagnoses are ranked properly. + Makes… more