DRG Reviewer
4 weeks ago
Under the direction of the Coding Department leaders, the Level 1 DRG Reviewer will conduct initial reviews of the claims within the internal CORE application.Responsibilities
- Analyze and review inpatient claims following the Official Coding and Reporting Guidelines to validate the reported ICD-10-CM/PCS codes to ensure proper DRG assignment for accurate billing.
- Demonstrates the ability to perform a comprehensive initial review as outlined in the standard operating procedures and departmental guides.
- Collaborates with physician reviewers, as needed.
- Ability to prioritize and organize workload and complete tasks independently.
- Required attendance of all departmental team meetings and/or training.
- Work on other duties or tasks, as necessary.
- Report productivity daily utilizing department productivity report.
- Meet/exceed productivity expectations as outlined in the department productivity policy.
- Maintains 95% accuracy in claim reviews.
- Complies with organization policy and procedures.
- Coding Certification required (at least one of the following is required and must be maintained as a condition of employment).
- Registered Health Information Administrator (RHIA)
- Registered Heath Information Technician (RHIT)
- Certified Coding Specialist (CCS)
- Certified Inpatient Coder (CIC)
- Candidates with a Registered Heath Information Technician (RHIT)
- Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP) or Certified Professional Coder (CPC) will be considered but will need to obtain an inpatient coding certification (CCS or CIC) within 12 months of hire.
- College level courses in medical terminology, anatomy, pathophysiology, pharmacology, and medical coding courses.
- At least 1 year of experience in MS-DRG and APR-DRG coding experience through acute care inpatient coding, auditing, and/or payment integrity DRG Validation.
- Adherence to the Official Coding and Reporting guidelines, AHA Coding Clinic determinations, and CMS and other regulatory compliance guidelines and mandates.
- Requires working knowledge of applicable industry-based standards.
- Proficiency in Outlook, Word, Excel, and other applications.
- Excellent written and verbal communication skills.
- Maintain professional credentialed status with approved continuing education programs
- Ability to work independently and can multi-task or transition to different tasks easily.
- Healthcare that fits your needs - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents.
- 401(k) with Employer Match - Join the team and we will invest in your future
- Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when you’re not feeling well, and 11 observed holidays.
- Wellness - We care about your well-being. From Commuter Benefits to FSAs we’ve got you covered.
- Learning & Development - Through continued education/mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional.
- High speed internet (100 Mbps per person recommended) with secured WIFI.
- A dedicated workspace with minimal interruptions to protect PHI and HIPAA information.
- Must be able to sit and use a computer keyboard for extended periods of time.
Powered by JazzHR
MFf7FNrBMT
-
Assistant Director of CDI
4 weeks ago
New York, United States NYC Health + Hospitals Full timeAbout NYC Health + Hospitals:Empower Every New Yorker — Without Exception — to Live the Healthiest Life PossibleNYC Health + Hospitals is the largest public health care system in the United States. We provide essential outpatient, inpatient and home-based services to more than one million New Yorkers every year across the city’s five boroughs. Our...
-
Assistant Director of CDI
1 month ago
New York, United States NYC Health + Hospitals Full timeAbout NYC Health + Hospitals:Empower Every New Yorker — Without Exception — to Live the Healthiest Life PossibleNYC Health + Hospitals is the largest public health care system in the United States. We provide essential outpatient, inpatient and home-based services to more than one million New Yorkers every year across the city’s five boroughs. Our...
-
Clinical Documentation Specialist
4 days ago
Hackensack, New Jersey, United States Hackensack Meridian Health Full timeAbout the RoleWe are seeking a highly skilled Clinical Documentation Specialist to join our team at Hackensack Meridian Health. As a key member of our clinical documentation improvement team, you will play a critical role in ensuring the accuracy and quality of clinical documentation that supports code assignment for compliance with billing regulations.Key...
-
Hackensack, New Jersey, United States Hackensack Meridian Health Full timeJob SummaryWe are seeking a highly skilled Physician Utilization Review Specialist to join our team at Hackensack Meridian Health. As a key member of our healthcare team, you will play a critical role in ensuring the integrity of clinical records for our patient population and the organization.Key ResponsibilitiesRegulatory ComplianceProvide direction and...
-
Appeals Coordinator level II
2 weeks ago
New York, United States MedReview Full timeJob DescriptionJob DescriptionPosition Summary At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare. As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews.Under the direction of the Appeals Department leaders, the Appeals...
-
Customer Service Representative
4 weeks ago
New York, United States MedReview Full time $20 - $21Job DescriptionJob DescriptionPosition Summary At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare. As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews.Under the direction of the Customer Service Department leaders, the Customer...
-
Customer Service Representative
2 months ago
New York, United States MedReview Full timeJob DescriptionJob DescriptionPosition Summary At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare. As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews.Under the direction of the Customer Service Department leaders, the Customer...
-
Systems Analyst
3 weeks ago
New York, United States NYC Health Hospitals Full timeElmhurst Hospital Center (EHC) is the major tertiary care provider in the borough of Queens. The hospital is comprised of 545 beds and is a Level I Trauma Center, an Emergency Heart Care Station and a 911 Receiving Hospital. It is the premiere health care organization for key areas such as Surgery, Cardiology, Women's Health, Pediatrics, Rehabilitation...
-
Neptune City, New Jersey, United States Hackensack Meridian Health Full timeJob SummaryWe are seeking a highly skilled Clinical Documentation Specialist, Registered Nurse to join our team at Hackensack Meridian Health. As a key member of our healthcare team, you will be responsible for ensuring the accuracy and completeness of patient medical records.Key ResponsibilitiesFacilitate accurate and complete clinical documentation to...
-
Clinical Documentation Specialist
4 days ago
Neptune City, New Jersey, United States Hackensack Meridian Health Full timeJob SummaryWe are seeking a highly skilled Clinical Documentation Specialist to join our team at Hackensack Meridian Health. The successful candidate will be responsible for facilitating the improvement of medical record documentation, ensuring accuracy and completeness, and promoting high-quality patient care.Key ResponsibilitiesFacilitate appropriate...
-
Neptune City, New Jersey, United States Hackensack Meridian Health Full timeAbout the RoleWe are seeking a highly skilled Clinical Documentation Specialist, Registered Nurse to join our team at Hackensack Meridian Health. As a key member of our healthcare team, you will play a critical role in ensuring the accuracy and completeness of patient medical records.Key ResponsibilitiesFacilitate accurate and complete clinical documentation...
-
Inpatient/Outpatient Coding Specialist
1 day ago
New York, New York, United States MetroPlusHealth Full timeAbout MetroPlusHealthMetroPlusHealth is a leading healthcare provider committed to empowering New Yorkers by uniting communities through care. Our mission is to provide high-quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens, and Staten Island.Job SummaryThe Inpatient/Outpatient Coder will be responsible for conducting coding...
-
Manager of Provider Audits and Education
2 weeks ago
New Orleans, Louisiana, United States LCMC Health Corporate Full timePosition OverviewThis role transcends traditional job responsibilities.The primary focus of this managerial position is to oversee physician audits and educational initiatives. This encompasses all medical and surgical specialties within a multi-hospital and academic framework. The selected candidate will be tasked with the effective implementation of...
-
Contract Analyst
4 weeks ago
New York, United States MedReview Full time $75,000 - $85,000Job DescriptionJob DescriptionPosition SummaryAt MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare. As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews.The purpose of this position is to provide analysis as well as monitor, guide...
-
Inpatient/Outpatient Coder
2 weeks ago
New York, United States Athari Full timeJob DescriptionJob DescriptionEmpower. Unite. Care.We are committed to empowering New Yorkers by uniting communities through care. We believe that Healthcare is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.Position OverviewThe Inpatient/Outpatient Coder is...
-
Medical Coding Specialist
2 days ago
New York County, New York, United States Athari Full timeEmpower. Unite. Care.We are committed to empowering New Yorkers by uniting communities through care. We believe that Healthcare is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.Position OverviewThe Inpatient/Outpatient Coder is responsible for conducting...
-
Manager - Appeal Operations
1 week ago
New York, United States MedReview Full timeJob DescriptionJob DescriptionPosition Summary:At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare. As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews. We are seeking an Appeal Operations Manager with experience in Inpatient...
-
Clinical Documentation Specialist
1 day ago
New York, New York, United States ChristianaCare Full timeJob Title: Clinical Documentation SpecialistChristianaCare is seeking a skilled Clinical Documentation Specialist to join our team. As a key member of our quality improvement team, you will play a critical role in ensuring accurate and complete clinical documentation.Key Responsibilities:Participate in performance improvement activities to enhance...
-
Manager of Provider Audit and Education
3 weeks ago
New Orleans, Louisiana, United States LCMC Health Corporate Full timePosition OverviewThis role transcends traditional job responsibilities.The primary focus of this managerial position will be on physician auditing and educational initiatives. This encompasses all medical and surgical services across various specialties within a multi-hospital and academic framework. The individual in this role will also oversee the...
-
Provider Audit and Education Manager
1 month ago
New Orleans, United States LCMC Health Corporate Full timeJOB DESCRIPTION Your job is more than a job The focus of this manager position will be on physician audit and education. This will include all medical and surgical services and specialties in a multi-hospital (and academic) setting. The incumbent will also be responsible for the successful implementation of hospital and professional based ED coding across...
