- Zelis (FL)
- …personal 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...Clinic and client specific coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest… more
- Zelis (NJ)
- …is responsible for conducting post-service, pre-payment and post pay comprehensive inpatient DRG Quality Assurance reviews in an effort to increase the savings ... achieved for Zelis clients. Conduct reviews on inpatient DRG claims as they compare with medical records utilizing ICD-10 Official Coding Guidelines, AHA Coding… more
- SSM Health (OK)
- …the principal diagnosis, pertinent secondary diagnoses, and procedures for accurate diagnosis review group ( DRG ) assignment, risk of mortality (ROM), and ... reflection of the patient condition in the associated Diagnosis Related Group ( DRG ) assignments, case-mix index, severity of illness (SOI), and risk of mortality… more
- Excellus BlueCross BlueShield (Rochester, NY)
- Job Description: Summary: The Payment Integrity DRG Coding & Clinical Validation Analyst position has an extensive background in acute facility-based clinical ... has a high level of understanding of the current MS- DRG , and APR- DRG payment systems. This position...and claims processing platform. . Manages case volumes and review /audit schedules, prioritizing case load as assigned by Management.… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …to educate physicians, nursing, and other clinical staff to improve documentation. + Review ?s DRG Reassignment letters and assists in formulating Appeal letters ... leadership programs and more! **Description** We are seeking an experienced **Inpatient DRG Coding Auditor** to extract data from patient encounters ensuring the… more
- Insight Global (South Jordan, UT)
- Job Description Insight Global is seeking a DRG Validation Auditor for one of our clients to sit 100% remote. This person should have an extensive background in ... a high level of understanding of reimbursement guidelines specifically an understanding of the MS- DRG , AP- DRG , and APR- DRG payment systems. This position is… more
- Elevance Health (Hanover, MD)
- …clinical reviews of medical records and other documentation to evaluate issues of coding and DRG assignment accuracy. Specializes in review of DRG coding via ... ** DRG CODING AUDITOR** **_Virtual_** **_: _** _ _...to recover, eliminate and prevent unnecessary medical-expense spending. The ** DRG CODING AUDITOR** is responsible for auditing inpatient medical… more
- HCA Healthcare (Nashville, TN)
- …personal growth, we encourage you to apply for our Coding Quality Audit Reviewer opening. We promptly review all applications. Highly qualified candidates will ... We care like family! Jump-start your career as a DRG Validation Auditor today with Parallon. **This position is...result in appropriate reimbursement and data integrity. You will review outcomes are communicated to the HSC team to… more
- Elevance Health (Las Vegas, NV)
- …clinical documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group ( DRG ) paid claims. **How you will ... **Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS- DRG , AP- DRG and APR- DRG )** **Virtual:** This role enables associates to work virtually… more
- Kaleida Health (Buffalo, NY)
- …and insurance / managed care practices including but not limited to: utilization review , RAC, MAC, Q10, clinical and DRG denial management required. **Working ... **Director Clinical and DRG Denials** **Location:** Larkin Bldg @ Exchange Street...Shift 1 Job Description **Summary:** The Director, Clinical & DRG Denials provides clinical leadership and administrative guidance to… more