- Hawaii Pacific Health (Lihue, HI)
- …to patients, physicians, and other outside facilities for treatment, payment, or review . HIS is the custodian and gatekeeper for privacy of the organization's ... accurate, and that reimbursement is received for services rendered to patients with DRG -based payers. You will also educate members of the patient care team on… more
- Albany Medical Center (Albany, NY)
- …education and feedback, projects assigned by management, and special requests to review coding for external departments such as quality management and CDI. ... and Responsibilities + Optimize hospital reimbursement by auditing and monitoring inpatient and outpatient records and investigating unbilled cases. + Understands… more
- Texas Health Resources (Arlington, TX)
- …Evaluate the effectiveness of internal controls and compliance procedures. Coding & Documentation Review - Assist the audit team with inpatient , outpatient, and ... best practices for areas vulnerable to compliance errors. Denial Support & Case Review - Conduct additional reviews to assist departments handling Medicare, OIG, or… more
- Molina Healthcare (Iowa City, IA)
- …all claim types of reimbursements not limited to payment methodologies such Stoploss, DRG , APC, RBRVS, FFS applicable for HD Inpatient , Outpatient and ... **Job Description** Responsible for comprehensive contract review and target claim audits review . This includes but not limited to; deep dive contract review … more
- Veterans Affairs, Veterans Health Administration (Bay Pines, FL)
- …on guidelines specific to certain diagnoses, procedures, and other criteria (in inpatient and outpatient settings) used to classify patients under the Veterans ... team, and as such, shall assist all clinical providers with ICD, CPT and DRG methodologies so that documentation will more accurately reflect the occurrence of the… more
- AdventHealth (Shawnee, KS)
- …patient and involved care givers (as permitted by the patient) as well as a review of the current and past inpatient and outpatient medical record in the ... team as needed. + Establishes and documents, based on the predicted DRG and multidisciplinary team member's input, Anticipated Date of Transition (ADOT) and… more
- AdventHealth (Bolingbrook, IL)
- …patient and involved care givers (as permitted by the patient) as well as a review of the current and past inpatient and outpatient medical record in the ... team as needed. . Establishes and documents, based on the predicted DRG and multidisciplinary team member's input, Anticipated Date of Transition (ADOT) and… more
- Cardinal Health (San Juan, PR)
- …and adequacy of documentation and coding related to physician or hospital ( inpatient and outpatient) billing and/or medical necessity reviews. + Manages focused ... data analytics and the revenue cycle team in identifying the time period of review and conducts a focused audit to identify any financial liability of the Company.… more
- AdventHealth (Hinsdale, IL)
- …patient and involved care givers (as permitted by the patient) as well as a review of the current and past inpatient and outpatient medical record in the ... team as needed. Establishes and documents, based on the predicted DRG and multidisciplinary team member's input, Anticipated Date of Transition (ADOT)… more
- Houston Methodist (Sugar Land, TX)
- …Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management and appeals ... denials for level of care, medical necessity, and as appropriate, DRG recoupments/downgrades, and denials for no authorization. The Senior Denials Management… more