- Molina Healthcare (Rochester, NY)
- …Complex Claim review including DRG Validation, Itemized Bill Review , Appropriate Level of Care, Inpatient Readmission, and any opportunity identified ... set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and experience,… more
- Stony Brook University (Commack, NY)
- …Comorbidities in ICD-10 CM books + Provide education to the CDI staff on the Inpatient Prospective Payment System. + Provide education to the CDI staff on the use of ... chapter. + Provide education to the CDI staff on DRG Expert reviews. Identify surgical DRG 's versus...staff on coding guidance on an ongoing basis. + Review and respond to coding questions. + Work in… more
- Northwell Health (Westbury, NY)
- …OASIS Specialist-Clinical. Job Responsibility 1.Leverages clinical expertise to identify and validate DRG code assignment. 2.Full review of CDI suggested code ... **Req Number** 155044 Job Description Validates Acute Inpatient coded charts to ensure the diagnostic information leading to the assignment can be substantiated by… more
- Rochester Regional Health (Rochester, NY)
- …proven leadership and management skills to promote effective and efficient review of physician documentation and the medical record. + Demonstrate knowledge ... program compliance to ensure adherence to all CMS regulations regarding DRG assignment. + Assume responsibility for professional development through participation at… more
- Northwell Health (Lake Success, NY)
- …clinical documentation in the patient's medical record through a concurrent review process throughout the patient's inpatient stay. 4.Requests clarification ... mortality, and complexity of care provided. Responsible for concurrent inpatient medical record reviews for Medicare, Medicaid and all...8.Demonstrates knowledge of ICD-10 CM and ICD-10 PCS coding, MS- DRG and APR NY and APR National grouper logic,… more
- Guthrie (Binghamton, NY)
- …through analysis of clinical and financial data, including length of stay and DRG profiling. Education, License & Cert: RN Bachelor of Science degree in Nursing ... of experience in an acute care setting with strong care management, utilization review , and payer knowledge. A Case Management certification or obtaining a Case… more
- Albany Medical Center (Albany, NY)
- …education and feedback, projects assigned by management, and special requests to review coding for external departments such as quality management and CDI. ... and Responsibilities + Optimize hospital reimbursement by auditing and monitoring inpatient and outpatient records and investigating unbilled cases. + Understands… more
- Molina Healthcare (Buffalo, NY)
- …all claim types of reimbursements not limited to payment methodologies such Stoploss, DRG , APC, RBRVS, FFS applicable for HD Inpatient , Outpatient and ... **Job Description** Responsible for comprehensive contract review and target claim audits review . This includes but not limited to; deep dive contract review … more
- Cardinal Health (Albany, NY)
- …and adequacy of documentation and coding related to physician or hospital ( inpatient and outpatient) billing and/or medical necessity reviews. + Manages focused ... data analytics and the revenue cycle team in identifying the time period of review and conducts a focused audit to identify any financial liability of the Company.… more
- Molina Healthcare (Buffalo, NY)
- …**E** **N** **C** **E:** + Min. 6 years' experience in healthcare claims review and/or member dispute resolution. + 2 years leadership experience + Experience ... reviewing all types of medical claims (eg HCFA 1500, Outpatient/ Inpatient UB92, Universal Claims, Stop Loss, Surgery, Anesthesia, high dollar complicated claims, COB… more