- Community Health Systems (Franklin, TN)
- **Job Summary** The DRG Denials Auditor conducts hospital inpatient DRG denial audits for both RAC and non-RAC accounts, reviewing patient records for ... accuracy in ICD-10-CM/PCS coding, DRG assignments, and supporting clinical documentation. This...denial and appeal status. + Consults with Coordinator and/or Director , Coding Denials and Appeals during any… more
- Hartford HealthCare (Farmington, CT)
- … denials . . Prepare, document and submit appeals for DRG denials , ensuring appeals are well-supported with clinical evidence, coding guidelines, and ... denial management and appeals. . Serve as the primary contact with payers on DRG -related denials . Effectively communicate the clinical and coding rationale… more
- University of Southern California (Alhambra, CA)
- …for coding-related denials , triage denied claims to distinguish coding-related denials versus clinical -related denials , evaluating claims deemed ... & state coding compliance regulations and guidelines, the HIM Coding Denials Management Specialist" analyze, investigate, mitigate, and resolve all coding-related… more
- Datavant (Nashville, TN)
- …should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and appeal writing for inpatient admission. Experience with ... clinical criteria resources and payor guidelines. **You will:** +...Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and appeal writing for… more
- Rochester Regional Health (Rochester, NY)
- Job Title: Director , CDI Department: Clinical Documentation ImprovementLocation: Riedman CampusHours Per Week: 40Schedule: Monday - Friday, 8am - 4:30pmSUMMARY ... The Clinical Documentation Improvement Director provides a key...system committees and work groups, including billing, revenue cycle, denials , and others as assigned. + Ensure effective staffing… more
- St. Luke's University Health Network (Allentown, PA)
- …reviews for clinical validation of diagnosis and procedure code assignment and MS- DRG /APR- DRG accuracy based on denials or audit findings from government ... patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records,...all diagnosis and procedure codes to assure properly assigned MS- DRG or APR- DRG for the purpose of… more
- Covenant Health Inc. (Knoxville, TN)
- …Working directly with the physicians, Manager of Corporate Coding Services, Director of Registration/Admitting, and medical staff education efforts, serves as the ... user advocate between Health Information Management (HIM), Clinical Effectiveness, and Registration. Other job duties include: improving health record documentation… more
- University of Southern California (Arcadia, CA)
- …recommendations on query structure, process, and workflow. Responds to coding denials with clinical justifications and coding conventions. Maintain ... for both formal and informal education for physicians, nursing, and other clinical staff. + Meets established productivity targets for record review and appropriate… more
- BronxCare Health System (Bronx, NY)
- …with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal Manager is responsible to develop a strong appeal ... the staff on identified deficiencies to best respond to all hospital denials notification and documentation efforts. The Appeals Manager will provide timely tracking… more
- Sharp HealthCare (San Diego, CA)
- … DRG coding and CPT coding classification. + Certified Clinical Documentation Specialist (CCDS) - Various-Employee provides certificate -PREFERRED + Certified ... Day **FTE** 1 **Shift Start Time** **Shift End Time** Certified Clinical Documentation Specialist (CCDS) - Various-Employee provides certificate; Other; Certified… more