- 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
- Kaleida Health (Buffalo, NY)
- …Quality Department and ancillary staff to perform concurrent analytical review of clinical documentation and coding data. Facilitates obtaining appropriate ... an accurate reflection of the patient condition in the associated DRG assignments, case-mix index, documentation/coded quality metrics, and reimbursement. Exhibits a… more
- Penn Medicine (Philadelphia, PA)
- …diagnoses, principal procedure, and secondary procedures accurately. Performs analysis of the DRG assigned to produce the highest level of reimbursement to which the ... provider community. Assist the Revenue Cycle Manager by completing the preliminary DRG report for Finance, and compiling additional reports as needed to demonstrate… more
- Trinity Health (Livonia, MI)
- …severity of illness, risk of mortality, clinical validity and proper DRG assignment. **ESSENTIAL FUNCTIONS** Knows, understands, incorporates, and demonstrates the ... system goals are met. Maintains current knowledge of the MS- DRG system, CCs/MCCs, impact on quality, risk of mortality,...direct reports perform clinical validation as part of the review process and remain current on CDI strategies. Maintains… more
- Deloitte (Los Angeles, CA)
- …nurse, physician, physician assistant, case manager, clinical documentation specialist, utilization review , informatics RN, Quality, DRG Validation and health IT ... regarding clinical documentation standards and clinical indicators which drive reimbursement, MS- DRG , APR- DRG , PSIs, HACs, POA, Vizient, Elixhauser, public… more
- Penn Medicine (Philadelphia, PA)
- …diagnoses, principal procedure, and secondary procedures accurately. Performs analysis of the DRG assigned to produce the highest level of reimbursement to which the ... provider community. Assist the Revenue Cycle Manager by completing the preliminary DRG report for Finance, and compiling additional reports as needed to demonstrate… more
- Penn Medicine (Philadelphia, PA)
- …are charted appropriately within defined regulatory timeframes + Assign a working MS- DRG upon initial admission review , and communicate with Physician or ... to reflect truth in diagnostic reflection. **Responsibilities:** + Direct review of patient charts to audit clarity and full...abstraction of clinical indicators, and the assignment of Initial DRG and Working DRG + Generate compliant… more
- University of Southern California (Alhambra, CA)
- …documentation needed to facilitate accurate and complete coding, abstracting, and DRG assignments. Participate in responses to inquiries regarding coding and ... 95% accuracy rate as determined by an annual external review of coding. + ABSTRACTING AUDITING * Performs monthly...and questions. + CODING OPTIMIZATION * Ability to improve MS- DRG assignments related to the documentation & coding of… more
- Centene Corporation (New York, NY)
- …and a NYS Driver's License or Identification card.** **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for all outpatient ... requiring authorization. Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care… more
- Houston Methodist (WA)
- …rules and regulatory body guidelines. This position performs data quality review to ensure data integrity, coding accuracy, and revenue preservation. Additional ... duties include participating in quality review and performance improvement projects throughout the department and/or facility. **PEOPLE ESSENTIAL FUNCTIONS** +… more