- 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
- LA Care Health Plan (Los Angeles, CA)
- …reimbursement policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management projects. The position ... and completeness of ICD, Rev Code, CPT, HCPCs, APR, DRG , POA, and all relevant coding elements. Audits can...POA, and all relevant coding elements. Audits can include inpatient , outpatient, and professional claims. Serves cross functionally with… 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
- Geisinger (Danville, PA)
- …the content of the medical record for hospital and professional inpatient records to identify principal diagnosis, secondary diagnoses and procedures performed ... severity and comply with standard provider coding regulations. + Carefully details review of documents such as laboratory findings, radiology reports, various scan… more
- Cardinal Health (Salt Lake City, UT)
- …and adequacy of documentation and coding related to physician or hospital ( inpatient and outpatient) billing and/or medical necessity reviews. + Prepares written ... application of Medicare/Medicaid documentation and coding rules and guidelines; ICD/CPT/HCPCS/ DRG /APC documentation coding rules; medical terminology; E/M rules; healthcare… more
- Ansible Government Solutions (Memphis, TN)
- …the Registered Nurse Advisor for the facility's CDI program, focusing on both inpatient and outpatient services + Review health records concurrently to identify ... Clinical Documentation Integrity Specialists (ACDIS) + Knowledge of ICD-10-CM and MS- DRG coding systems + Experience with electronic health record systems,… more
- Kaleida Health (Buffalo, NY)
- …is responsible for coding, including, but not limited to any type of inpatient /or outpatient medical records for the purpose of data quality, accurate reimbursement, ... and state regulations. Diagnoses and procedures are coded through review of the entire medical record, utilizing the International...in coding with ICD 10, PCS, CPT Coding and DRG /APC assignment in an acute care facility preferred. Prior… more