direction of the DRG Operations Department leaders, the DRG Reviewer will conduct reviews of inpatient claims for both coding.... As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews. Under the...
Anticipated End Date: 2026-02-26 Position Title: DRG Clinical Validation Auditor (RN/Claims Reviewer...) Job Description: DRG Clinical (RN) Validation Auditor Virtual: This role enables associates to work virtually full-time...
balance, continuous learning, and career development. Summary We are seeking a talented individual for a DRG Nurse... Reviewer Appeals and Hearings to coordinate and perform all appeal related duties including analyzing and responding...
balance, continuous learning, and career development. Summary We are seeking a talented individual for a DRG Nurse... Reviewer Appeals and Hearings to coordinate and perform all appeal related duties including analyzing and responding...
Empower AI: As a Medical Review Specialist III (Medical Reviewer III) for Empower AI, Inc., you will perform Medicare... comprehensive medical record and claims review to make payment determinations for Diagnosis Related Group (DRG) claims. Perform...
: Empower AI: As a Medical Review Specialist III (Medical Reviewer III) for Empower AI, Inc., you will perform Medicare... comprehensive medical record and claims review to make payment determinations for Diagnosis Related Group (DRG) claims. Perform...
reviews of MS-DRG and APR-DRG coding and clinical documentation to ensure the accuracy of DRG assignment and reimbursement... errors or upcoding. Operates with significant autonomy in supporting DRG validation reviews and appeals, interpreting...
(EOB) Reviewer ensures all that all Commercial and Managed Care payments and adjustments are posted correctly, and that the... Technical knowledge of all reimbursement methodologies, APC, DRG, Per Diem, etc. Abilities Strong analytical and math...
Title: Clinical Reviewer RN Location: Remote (must hold an unrestricted Massachusetts RN license) Duration: 5-month... is not required. Overview: We are seeking an experienced Inpatient RN Utilization Reviewer to independently manage a clinically complex...
, please review this . The Clinical Documentation Integrity (CDI) Second Level Reviewer performs high-level, complex, secondary case... for CDI/Coding/Quality. The CDI Second Level Reviewer works in collaboration with CDI & quality leadership, CDI specialists...
Duration: 4 months contract (with possible extension) Job Description: The Clinical Reviewer, Inpatient RN..., and others. The Clinical Reviewer, Inpatient RN is responsible for making the determination of medical necessity and, therefore...
associated Diagnosis Related Group (DRG) assignments, case-mix index, severity of illness (SOI), and risk of mortality (ROM... and completeness of supporting documentation to determine a working and final DRG, SOI, and/or ROM. Job Responsibilities...
as second-level reviewer through the review of medical records of patients identified by care managers or as requested by the... of mortality, and DRG assignments on their individual patient records. Works with the EHR team and quality officers...
the integrity of clinical documentation through the roles of reviewer, educator and consultant. The CDI Specialist..., establishing a working principle diagnosis and working DRG (MS or APR). Collaborates with coding staff to ensure documentation...
-level reviewer through the review of medical records of patients identified by care managers or as requested by the... of mortality, and DRG assignments on their individual patient records. Works with the EHR team and quality officers...
claims reviewer team and the resolution team), ensuring that all metrics are achieved for quality, time, inventory, and aging... issues and drive root-cause elimination. Ensure correct application of pricing methodologies (DRG, APR-DRG, fee schedules...
clinical and coding expertise to direct efforts toward the integrity of clinical documentation through the roles of reviewer... diagnoses codes, establishing a working principle diagnosis and working DRG (MS or APR). Collaborates with coding staff...
roles of reviewer, educator and consultant. Facilitates the overall quality, completeness, accuracy, and integrity..., or Clinical Documentation and experience in ICD-10 coding conventions and DRG methodology preferred. Position Highlights...
, which will provide an accurate MS-DRG or APR-DRG for appropriate reimbursement. Ensures all accounts are coded within 4 days of the... to the appropriate patient's encounter. While reviewing the record for coding purposes, serves as a quality reviewer...