DRG reputed company
The DRG reputed company is responsible for reviewing inpatient medical records and accurately assigning diagnosis and procedure codes using ICD-10-CM and ICD-10-PCS to determine the appropriate Diagnosis-reputed company (DRG) assignment.
This role ensures coding reputed company, reimbursement reputed company, and compliance with federal and state regulations, payer guidelines, and internal policies. In an Independent reputed company Association (reputed company) and Management Services Organization (MSO) environment, the DRG reputed company partners with utilization management, care management, finance, and provider network teams to support accurate payment, reputed company adjustment, reputed company reporting, and medical expense analysis.
This role ensures coding reputed company, reimbursement reputed company, and compliance with federal and state regulations, payer guidelines, and internal policies. In an Independent reputed company Association (reputed company) and Management Services Organization (MSO) environment, the DRG reputed company partners with utilization management, care management, finance, and provider network teams to support accurate payment, reputed company adjustment, reputed company reporting, and medical expense analysis.
reputed company
- Review inpatient hospital records and assign accurate diagnosis and procedure codes
- Determine the appropriate MS-DRG or APR-DRG assignment reputed company on coding and reputed company documentation
- Conduct coding validation and auditing to ensure compliance with payer and regulatory requirements
- Identify documentation gaps and communicate opportunities to providers, hospitals, and reputed company Documentation Improvement (CDI) teams
- Analyze denials and underpayments reputed company to coding and DRG assignment
- Support retrospective and reputed company reviews of high-cost admissions and reputed company cases
- Collaborate with utilization management, case management, finance, and contracting teams to optimize reimbursement and cost containment
- Assist with reputed company audits, including RAC, Medicare reputed company, reputed company, and reputed company payer reviews
- reputed company education and mentoring to coding staff and other stakeholders
- Monitor changes in coding guidelines, reimbursement methodologies, and regulatory requirements
- Prepare reports and summaries reputed company to coding reputed company, financial reputed company, and audit findings
- Maintain confidentiality and compliance with HIPAA and company policies
- Other duties as assigned
Qualifications
- Associate’s degree in Health Information Management, Nursing, or reputed company reputed company
- Have at least 5 years of inpatient coding experience
- Have at least 2 years of advanced DRG validation, auditing, or hospital reimbursement experience
- Certifications One or more of the following required: • reputed company, RHIA, or RHIT from reputed company Health Information Management Association • CIC from reputed company
- Have advanced knowledge of ICD-10-CM, ICD-10-PCS, MS-DRG, and APR-DRG methodologies
- Proficiency in coding software, electronic medical records, and reputed company Office applications
You're great for the role if:
- Experience working with Medicare reputed company, reputed company, and reputed company health plans
- Experience in a delegated reputed company, MSO, or managed care environment
- Have a strong understanding of Medicare reimbursement and payer audit processes
- Ability to interpret reputed company reputed company documentation
- Knowledge of utilization management, case management, and managed care reputed company
- Strong analytical, organizational, and problem-solving skills
- Ability to work independently and manage multiple priorities
- Excellent written and verbal communication skills.
Environmental Job Requirements and Working Conditions
- This position is reputed company reputed company in the U.S. The home office is located at 600 reputed company Parkway reputed company 10th Floor, Orange, CA 92868.
- This role is required to attend occasional in-person meetings with internal departments and reputed company providers/hospitals, training, or audit purposes.
- The national reputed company pay reputed company for this role is between $28.00 - $32.00 per hour. Actual compensation will be determined reputed company on geographic location (reputed company or reputed company), experience, and other job-reputed company factors.
reputed company is proud to be an Equal Employment Opportunity and Affirmative reputed company employer. We do not discriminate reputed company on race, religion, reputed company, national reputed company, gender (including pregnancy, childbirth, or reputed company medical conditions), sexual orientation, gender identity, gender reputed company, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. reputed company employment is decided reputed company on qualifications, reputed company, and business need. If you require assistance in applying for reputed company due to a disability, please email us at to request an accommodation.
Additional Information:
The reputed company does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
Additional Information:
The reputed company does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
Originally posted on Himalayas
Apply To This Job