- HCA Healthcare (Nashville, TN)
- …growth, we encourage you to apply for our Coding Quality Audit Reviewer opening. We promptly review all applications. Highly qualified candidates ... vary by location._** Come join our team as a Coding Quality Audit Reviewer...result in appropriate reimbursement and data integrity. You will review outcomes are communicated to the HSC team to… more
- Geisinger (Danville, PA)
- …and practices, proper documentation techniques, medical terminology, and disease processes. + Completes coding quality audit reviews to ensure all available ... admission and patient severity and comply with standard provider coding regulations. + Carefully details review of...within the patient's record to facilitate complete and accurate coding . + Communicates to Coding Quality… more
- Elevance Health (Chicago, IL)
- …based DRG Coding / Clinical Validation Audit setting or hospital coding or quality assurance environment preferred. + Broad, deep and niche knowledge of ... all lines of business, and its clients. Specializes in review of DRG coding via medical record...or appeals may only be reviewed by other DRG Coding Audit Principals (or Executives). **How you… more
- Elevance Health (Ashburn, VA)
- …Group (DRG) Coding /Clinical Validation Audit setting or hospital coding or quality assurance environment preferred. + Broad knowledge of medical ... medical records and other documentation to evaluate issues of coding and DRG assignment accuracy. Specializes in review...information to make audit determinations and generate audit findings letters. + Maintains accuracy and quality… more
- Zelis (St. Petersburg, FL)
- …role with production and quality metric goals. What you'll do: + Review provider disputes for DRG Coding and Clinical Validation (MS and APR) ... findings. + Research and analysis of content for DRG review s . + Use of strong coding...review content, including but not limited to DRG Reviewer Rationales, DRG Clinical Validation Policies and Dispute Rationales… more
- Dana-Farber Cancer Institute (Brookline, MA)
- Reporting to the Director of Billing Compliance, the Senior Billing Compliance Reviewer will be responsible for the identification and performance of Billing ... Compliance inpatient and ambulatory activities. The Senior Reviewer will assist in the development and execution of the annual Billing Compliance work plan. They… more
- Zelis (FL)
- …interests that shape who you are. Position Overview The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay ... comprehensive inpatient DRG reviews based on industry standard inpatient coding guidelines and rules, evidence based clinical criteria plan, and policy exclusions.… more
- City of New York (New York, NY)
- …with all statutory, regulatory and contractual standards. The Process Evaluation Review Team (PERT) is tasked with aggressively monitoring program compliance with ... Principal Administrative Associate, to function as a Senior Case Reviewer who will: - Conduct legally mandated case reviews...(Reynolds, Lovely H., MKB, Dajour, Davila, Brown, etc). Convert audit findings into reports that is presented to Family… more
- Zelis (NJ)
- …responsible for conducting post-service, pre-payment and post pay comprehensive inpatient DRG Quality Assurance reviews in an effort to increase the savings achieved ... as they compare with medical records utilizing ICD-10 Official Coding Guidelines, AHA Coding Clinic evidence based...What you'll do: + Perform comprehensive inpatient DRG validation Quality Assurance reviews to determine accuracy of the DRG… more
- St. Luke's University Health Network (Allentown, PA)
- …be responsible for performing internal, concurrent, prospective and retrospective coding audit activities. The incumbent will also review and validate coded ... medical records of the Professional Coding (PC) staff to determine data quality ...one-on-one education sessions for PCs needing focused attention on audit findings. In addition, works in conjunction with network… more
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