DRG (Coding) Reviewer/Auditor - New York

We are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews. · ...

We're seeking a Clinical DRG Auditor to perform inpatient Diagnosis-Related Group (DRG) validation audits and detailed clinical reviews of medical records and claims. · Active Registered Nurse (RN) license or Licensed Practical Nurse (LPN) license. · 3+ years of experience perfor ...

The Coding Integrity Auditor is responsible for upholding coding standards in business/industry/legislative issues related to quality coding audit and compliance. · Bachelor's degree in healthcare or related field · AAPC certifications (CPC, CIC) · ...

Provides consultative services for quality improvement activities at VNS Health Plans.Collaborates with clinical management to develop quality improvement standards. · Evaluates effectiveness of standards and recommends changes. · Ensures Quality Improvement programs align with C ...

The Inpatient DRG Validation Auditor is a valued member of the Penstock Audit team responsible for reviewing inpatient claims and ensuring that the DRG paid is fair and accurate based on the documentation in the medical record and the application of ICD-10-CM and ICD-10-PCS codin ...

This position provides consultative services and manages quality improvement activities for VNS Health Plans. The Quality Reviewer/Auditor contributes to the development of whole system measures and annual Enterprise quality strategic plan. · ...

Provides consultative services and manages quality improvement activities and initiatives for VNS Health Plans. · ...

Remote DRG Validator and Quality Reviewer performs inpatient coding and DRG validation & other reviews by verifying coding accuracy & compliance. · ...

The Clinical Reimbursement Manager role involves validating diagnostic information to confirm accuracy of coded data ensuring high quality compliance regulatory requirements. · Performs SMART focused reviews on ICD-10-CM/PCS coded inpt medical records to validate accuracy of code ...

We're seeking an experienced · Perform APR-DRG inpatient reviews and validate severity captureLead Risk of Mortality (ROM) and POA coding reviews and reportingReview HACs, PPCs, PSIs, · , and expired patient recordsStrong IP/OP Auditing / coding experience,Advanced knowledge of ...

The purpose of DRG validation is to confirm that diagnostic, procedural information and the discharge status of the beneficiary as coded and reported by the hospital on its claim matches both the attending physician's description and the information contained in the beneficiary's ...

The Mount Sinai Health System is committed to fostering an environment where everyone can contribute to excellence. We share a common dedication to delivering outstanding patient care. When you join us, you become part of Mount Sinai's unparalleled legacy of achievement, educatio ...

The purpose of DRG validation is to confirm that diagnostic, procedural information, and the discharge status of the beneficiary matches both the attending physician's description and the information contained in the medical record. · The Clinical Reimbursement Manager reviews qu ...

The purpose of DRG validation is to confirm that diagnostic procedural information and the discharge status of the beneficiary as coded by the hospital matches both attending physician description. · The Clinical Reimbursement Manager reviews medical records for quality accuracy ...

The purpose of DRG validation is to confirm that diagnostic, procedural information, and the discharge status of the beneficiary as coded and reported by the hospital on its claim matches both the attending physician's description and the information contained in the beneficiary' ...

The Clinical Reimbursement Manager will perform quality reviews of medical records to validate correctness and appropriateness of assigned International Classification of Diseases codes and Diagnosis Related Groups. · Performs SMART focused reviews on ICD-10-CM/PCS coded inpt med ...

The purpose of DRG validation is to confirm that diagnostic, procedural information, and the discharge status of the beneficiary, as coded and reported by the hospital on its claim matches both the attending physician's description and the information contained in the beneficiary ...

We're seeking an experienced IP/OP Coding Lead to provide advanced inpatient and outpatient coding review, risk adjustment oversight, and regulatory reporting support. · ...

This Clinical Coding Auditor & Trainer position requires travel to New York twice a year. The candidate must have an RN or PA license and at least 4 years of DRG and/or Medical Record Audit experience. · ...

We're looking for someone who can lead a team of professionals responsible for annotating and validating medical data, · Partner with our AI Engineering Product and Claims teams to train and refine generative AI models incorporating clinical insights · Provide clinical input to p ...