Anticipated End Date: 2026-01-30 Position Title: Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS-DRG..., AP-DRG and APR-DRG) Job Description: Title: Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS-DRG, AP...
, as well as validation of accuracy and completeness of all coding elements, and medical necessity reviews Responsible... insurance claims 2+ years of experience with medical records review / auditing including MS-DRG coding validation...
, including requirements gathering, data validation, analysis, and delivery of insights. Experience analyzing multiple data... Hierarchical Condition Category (HCC) coding, hierarchical models, and member risk scoring. Preferred: Experience with advanced...
, as well as validation of accuracy and completeness of all coding elements, and medical necessity reviews Responsible... insurance claims 2+ years of experience with medical records review / auditing including MS-DRG coding validation...
validation to reduce errors. Multi-agent patterns: Specialized agents (e.g., researcher, coder, reviewer) coordinating... Development: Implement security best practices across web applications and APIs, including OAuth2, JWT, and secure coding...
facility. This person will be instrumental in providing coaching and education to our remote DRG Validation Specialists... utilizing core coding and clinical information. We are seeking self-motivated, solution oriented and skilled problem solvers who...
. The Pre Pay Claim Validation Team Lead (Recovery Resolution Consultant) will be responsible for aiding and supporting the..., and task assignment and ensure escalations are responded to timely Be responsible for responding to complex coding case...
validation of billing system edits to ensure claims contain appropriate codes, activity-type, revenue codes and functionality.... Manage requests for new charges, providers, services, and prices through point-of request through charge validation when...
relationships. The position is accountable for physician coding audits, hospital inpatient and outpatient auditing activities..., and documentation align with: NYS OMIG Compliance Program requirements OIG Compliance Program Guidance CMS billing, coding...
the Service Validation Unit (SVU). This role ensures timely, accurate, and complaint processing across all lines.... Establishes and leads the Service Validation Unit (SVU) to function in a strategic, proactive and preventative manner...
, including data mining, recovery validation, provider outreach, and reconciliation, are accurate, transparent, and compliant..., accuracy, and reduction of rework. Oversees identification and validation of overpayments and underpayments from solicited...
Professional Coder (CPC) or other equivalent Coding Certification Required Training Physical Requirements Light Additional..., coding standards, and regulatory requirements. The Manager oversees operational QA testing, examiner-level audit programs...
validation or complex SQL/data analysis. Coding experience or equivalent knowledge. Skills Required: Expert-level... Professional Coder (CPC) or other equivalent Coding Certification Required Training Physical Requirements Light Additional...
and Director of DRG Validation to help develop coding education and training and institutional coding policies to achieve coding... and ICD-10-PCS coding is required. • Minimum of 3 to 5 years of experience coding in an acute care hospital. Validation...
Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Revenue Cycle Representative (CRCR), or Certification... compliant, accurate charge capture processes across the health system. The role collaborates with clinical departments, coding...
of risk adjustment initiatives (HCC, RAF scoring), collaborate with coding teams and providers to ensure accurate capture..., including quality, coding, IT, clinical department leadership and compliance, to align goals. JOB DUTIES/RESPONSIBILITIES...
certifications: (1) Certified Coding Specialist (CCS) from AHIMA, (2) Certified Professional Coder (CPC) from AAPC, (3) Registered... Job Summary: The Clinical Documentation Integrity (CDI) Auditor must be good at problem-solving, clinical and coding knowledge...
-on and coding architect, designing and overseeing the development of the foundational technology infrastructure that serves as the...) for validation and contributes significantly to team commitments, focusing on the most critical problems. This individual...
Medical Coder to help shape this critical function from the ground up. If you’re passionate about coding accuracy, payment... Claims Processing and Reimbursement ICD-10 Coding & DRG Validation Healthcare Revenue Cycle Operations Confidence...
plus $5.09 for Health and Wellness Role Summary Responsible for accurate, timely facility inpatient coding and data validation...Job Summary: Medical Records Technician (Coder) – Inpatient Facility (ICD-10-PCS) Location/Hours: Remote - Monday...