- Geisinger (Danville, PA)
- …for new members to the CDI team. Educate individuals and team members on the review functions within the CDI program in order to meet and maintain enterprise, goals ... of illness, risk of mortality, quality measure and metric support, and DRG assignment in compliance with industry rules and regulations, for completeness and… more
- Rochester Regional Health (Rochester, NY)
- …and quality in the medical record. This involves extensive record review and interaction with physicians, health information management professionals, and nursing ... of care, and quality + Accurate and timely record review + Recognize opportunities for documentation improvement + Formulate...A and Part B guidelines and how they impact DRG assignments (upon completion of training) + Knowledge of… more
- Houston Methodist (Sugar Land, TX)
- …Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management and appeals ... denials for level of care, medical necessity, and as appropriate, DRG recoupments/downgrades, and denials for no authorization. The Senior Denials Management… more
- Abbott (Austin, TX)
- …for Clinical Trial Reimbursement (CTR). **What You'll Work On** + Review clinical investigative plan and payer policies (Medicare, Medicare Advantage, Medicaid ... Management, Electrophysiology, Heart Failure, Neuromodulation, Structural Heart and Vascular. + Review , analyze for risk as needed and provide guidance and… more
- LA Care Health Plan (Los Angeles, CA)
- …reimbursement policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management projects. The position ... and completeness of ICD, Rev Code, CPT, HCPCs, APR, DRG , POA, and all relevant coding elements. Audits can...lead on any issues identified during research or claims review . Applies subject expertise in evaluating business operations and… more
- MaineGeneral Health (Augusta, ME)
- …overutilization. + Lead or actively participate in the Utilization Review Committee, ensuring compliance with regulatory requirements, reviewing utilization data, ... with CDI and HIM teams to improve documentation for accurate coding and DRG assignment, educate medical staff on best practices, and assist with denial management… more
- CareFirst (Baltimore, MD)
- …partnering hospital. This role will assist leadership with the development and review of Care Management standards, program criteria, policies, and procedures to ... **Experience:** 3 years Care Management, Discharge Coordination, Home Health, Utilization Review , Disease Management or other direct patient care experience with… more
- Veterans Affairs, Veterans Health Administration (Fort Meade, SD)
- …and completeness of clinical documentation. Inpatient CDI focuses on the concurrent review of patient records with an emphasis on improving documentation while the ... encounters through retrospective, ideally prior to coding and billing, review of outpatient encounters and extensive provider education. Applies comprehensive… more
- Veterans Affairs, Veterans Health Administration (Houston, TX)
- …and completeness of clinical documentation. Inpatient CDI focuses on the concurrent review of patient records with an emphasis on improving documentation while the ... possess knowledge of complication or comorbidity/major complication or comorbidity (CC/MCC), MS- DRG structure, and POA indicators. vii. Knowledge of severity of… more
- Community Health Systems (Springdale, AR)
- …system. + Successfully groups diagnoses and procedure codes into the appropriate DRG . + Successfully groups diagnoses and procedure codes into the appropriate APC. ... and coding questions. + Consistently follows the CHS post bill discharge summary review policy and procedure. + Consistently works on the bill error and edit… more