- 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
- Excellus BlueCross BlueShield (Rochester, NY)
- …agencies. Essential Accountabilities: Level I + Functions as a clinical reviewer of medical records, researching and investigating complex medical cases. Interprets ... Office of Professional Discipline and/or internal referral for quality review by the applicable business area. + Acts as...and/or clinical consultants. + Serves as an internal auditor/peer reviewer for new clinical staff, as needed. + Mentors… 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
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …the direction of Coding and Documentation leadership, provides active concurrent review , feedback, and education to physicians and healthcare providers to improve ... to ensure an accurate reflection of the patient condition in the associated MS- DRG assignments, case-mix index, severity of illness and risk of mortality profiling… more
- Marshfield Clinic (Marshfield, WI)
- …Uniform Hospital Discharge Data Set (UHDDS) and assignment of the appropriate MS- DRG (Medicare Severity-Diagnosis Related Group) or APR- DRG (All Patients Refined ... co-morbidities and complications, secondary conditions, surgical procedures and/or other procedures. + MS- DRG /APR- DRG + Present on admission indicators + HAC… more
- UNC Health Care (Kinston, NC)
- …role when needed. Working with Clinicians and Coders to successfully implement documentation review for MS- DRG and AP- DRG payers on assigned Hospital ... for all audit and appeals work activities. Assists with documentation review to support the clinical documentation specialists and Patient Financial Services.… more
- Datavant (Annapolis, MD)
- …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
- St. Luke's University Health Network (Allentown, PA)
- …records identified by RAC/MIC/CGI/QIO and other outside auditors in retrospective reviews for DRG and coding-related issues. May participate in review of other ... all diagnosis and procedure codes to assure properly assigned MS- DRG for the purposes of appealing proposed MS- DRG...MS- DRG for the purposes of appealing proposed MS- DRG and coding changes by insurance providers or their… more