- Children's Mercy Kansas City (Kansas City, MO)
- …Conducts concurrent review for documentation integrity and working diagnosis-related group ( DRG ) assignment. + Conducts focus review of facility KPI trends. ... purpose of education and communication to physicians and hospital leadership. Review admissions concurrently to identify an initial working Diagnosis-Related Group (… more
- Veterans Affairs, Veterans Health Administration (IN)
- …or impacting treatment to correctly determine the proper Diagnosis Related Group ( DRG ). Upon patient admission to the Community Living Center/Nursing Home Care Unit, ... and outpatient records. Inpatient duties consist of the performance of a comprehensive review of documentation within the health record to assign ICD CM and PCS… more
- Oracle (Little Rock, AR)
- …of care, clinical validation) to lead the appeals initiative to review denied claims, create write-ups for appeals packets, identify trends/improvement opportunities ... Improvement experience. + Knowledge of medical and insurance terminology, MS- DRG , APR- DRG , CPT, ICD coding structures, and...payor rules and regulations. + 2-3 years of Utilization Review experience in a healthcare setting preferred; 1-2 years… more
- Dignity Health (Rancho Cordova, CA)
- …emergency department, same-day surgery, and observation charts if needed. + Review provider documentation to determine the principal diagnosis, co-morbidities and ... Coding in relation to DRGs + Abstract additional data elements during the chart review process when coding, as needed + Utilize technical coding principals and MS-… more
- University of Southern California (Alhambra, CA)
- …a minimum of 95% coding accuracy rate as determined by any internal or external review of coding and/or department quality review (s). + Ability to achieve a ... data elements as determined by any internal or external review of coding and/or department quality review (s)....on coding issues and questions. + Ability to improve MS- DRG assignments specific to the documentation & coding of… more
- University of Utah (Salt Lake City, UT)
- …Recruitment** External Posting **Pay Rate Range** $47,600-$70,000 **Close Date** 02/13/2026 **Priority Review Date (Note - Posting may close at any time)** **Job ... **Responsibilities** **Essential Functions** + Supports Compliance Administrator in policy review and creation. + Monitors and assists in drafting required… more
- Datavant (Nashville, TN)
- …Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical necessity and necessity of continued stay ... should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and appeal writing for inpatient admission. Experience with clinical… more
- Molina Healthcare (Rochester, NY)
- …team and key stakeholder meetings (PowerPoint) + Coordinates and provides peer review of our quarterly national contract performance analysis by team members to ... reports and makes recommendations based on relevant findings. + Provides peer review of pricing configuration to ensure accuracy of financial modeling + Provides… more
- Northwell Health (Glen Cove, NY)
- …the Medical Record. Job Responsibility 1.Leverages clinical expertise to identify and validate DRG code assignment. 2.Full review of CDI suggested code changes ... State regulations. 5.Applies coding rules and regulations to the validation review process. 6.Reviews codes on Medicare/non-Medicare charts for compliance to rules… more
- Molina Healthcare (NM)
- …team and key stakeholder meetings (PowerPoint) * Coordinates and provides peer review of our quarterly national contract performance analysis by team members to ... reports and makes recommendations based on relevant findings. * Provides peer review of pricing configuration to ensure accuracy of financial modeling * Provides… more