- 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
- Humana (Montgomery, AL)
- …Management organization, including offshore and vendor partners, with a focus on DRG audits. You will also drive process improvement initiatives and develop ... looking is an experienced and well-grounded medical coding auditor to quality review the inpatient hospital claims for proper reimbursement, handle provider disputes… more
- CVS Health (Hartford, CT)
- …Knowledge of Aetna clinical and coding policy and experience with appeals, claim review , reimbursement issues, and coding is preferable, but a willingness to learn ... Director role include support of the appeal process, clinical claim review process, pre-certification, and predetermination of covered benefits in the Commercial… more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of ... all diagnosis and procedure codes to assure properly assigned MS- DRG or APR- DRG for the purpose of...appropriate reimbursement. + Work with the physician advisor in review of patient medical records identified by RAC/MIC/QIO and… more
- Hartford HealthCare (Farmington, CT)
- …practices. *_Position Responsibilities:_* *Key Areas of Responsibility* *Denial Resolution* . Review DRG validation denials from payers, analyze the denial ... 2 is responsible for reviewing, analyzing, and appealing denials related to DRG (Diagnostic Related Group) validation denials. This role involves validating the… more
- R1 RCM (Denver, CO)
- …completeness and accuracy. This person will identify potential coding and DRG errors, researches appropriate guidelines to support recommended changes, and ... to the coder involved on a timely basis. The Reviewer provides expert coding advice to coding staff and...+ Audits records as defined in the coding quality review plan. + Review cases flagged by… more
- St. Luke's University Health Network (Allentown, PA)
- …data and coding of all diagnosis and procedure codes to assure properly assigned MS- DRG for the purposes of appealing proposed MS- DRG and coding changes by ... retrospective medical record reviews for diagnosis and procedure code assignment and MS- DRG accuracy for inpatient encounters and CPT assignment for OP encounters.… more
- Hartford HealthCare (Farmington, CT)
- …alpha numeric diagnosis/procedure codes and Medicare Severity Diagnosis Related Groups (MS- DRG ). Data is classified for internal and external statistical reporting, ... and/or encoder, coding manuals and other reference material. 3. Reviews DRG assigned to each record. Enters coded/abstracted information into software, analyzes… more
- Hartford HealthCare (Farmington, CT)
- …alpha numeric diagnosis/procedure codes and Medicare Severity Diagnosis Related Groups (MS- DRG ). Data is classified for internal and external statistical reporting, ... and/or encoder, coding manuals and other reference material. 3. Reviews DRG assigned to each record. Enters coded/abstracted information into software, analyzes… more
- RWJBarnabas Health (Oceanport, NJ)
- …is responsible for ensuring accuracy and integrity of ICD-10-CM/PCS coding and DRG assignment for inpatient Medicare encounters. This requires critical thinking and ... and integrity of ICD-10-CM/PCS, CPT coding when applicable and DRG assignment for adherence to Federal and State Regulations...a team with other Quality Officers to ensure SMART review goals are met for all RWJBarnabas facilities. +… more