- 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
- US Tech Solutions (Columbia, SC)
- …8AM-4:30PM. + A typical day would like in this role: The normal day is DRG reviews and audits. + Performs validation reviews of Diagnosis Related Groups ( DRG ), ... **Responsibilities:** + Determines methodology to identify cases for validation review . + Conducts validation reviews/coordinates rates adjustments with appropriate… 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
- 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