Submit insurance claims, work denials, post insurance payments, file appeals when appropriate and keep up to date on knowledge of current insurance reimbursement rates and issues. Work in Sandata Software, clearinghouses, and payor portals. V. Position Expected Hours of Work Typical hours are full time 40 hours, Monday through Friday, 8 00AM through 4 30PM. VI. Essential

This position is accountable for the development, implementation, maintenance, and adherence to the organization's privacy program in collaboration with legal counsel and management, key departments, and committees to ensure organization has and maintains appropriate privacy and confidentiality consent, authorization forms, and information notices and materials reflecting

Assigns or verifies CPT, ICD 10 CM coding and modifiers based upon documentation. Subject matter expert in one or more specialties and may also cover multiple surgical/medical specialties for abstraction, ambulatory and/or surgical/procedural coding. Ensures compliance with official coding guidelines. Resolves edits for various charges, following established policies and

Monthly monitoring of the clinical dashboard demonstrating improvement in statistical targets. Communicates with Leadership across the regions to develop educational programs that address the identified opportunities to improve clinical dashboard results Identifies strategic plans that will positively impact the clinical dashboard Through relationship development across t

Include Ensure patient demographic information is accurate and complete Utilize customer hospital systems or approved vendors to research and obtain/verify patient demographic information Validate signature documents such as AOB (Assignment of Benefits), consents, CMN (Certificate of Medical Necessity) Verify patient name is consistent on all documents Verify date of servi

Assigns appropriately sequenced and compliant ICD 10 CM/PCS codes as documented in the electronic medical record (EMR). Applies definition of principal diagnosis for proper assignment of MS DRGs, APR DRGs, and POA indicators using a designated encoder/grouper, while ensuring compliance with nationally established coding guidelines. Utilizes selected encoder and/or compute

Area Lead Health Information Specialist (REMOTE & TRAVEL) Job Locations US WI Appleton Requisition ID 2024 35788 # of Openings 1 Category (Portal Searching) Operations Position Type (Portal Searching) Employee Full Time Overview Who we are... Datavant protects, connects, and delivers the world's health data to power better decisions and advance human health. We are a data

Utilizes technical coding expertise to assign appropriate ICD 10 CM and ICD 10 PCS codes to acute rehab cases and inpatient OB and Newborn discharges. Complexity is measured by a Case Mix Index (CMI) and IP Coder Associate's typically see average CMI's of 0.5759 with the OB and Newborn population. This index score demonstrates lower patient complexity and acuity. Utilizes

Principal Healthcare Data Analyst Systemwide Quality Improvement Category Data Solutions Job Location Remote Tracking Code 134678 Industry Health Care Job Level Mid Career Position Type Full Time/Regular Years of Experience 10+ to 15 Years Who is Comagine Health? Comagine Health is a national, nonprofit, health care consulting firm. We work collaboratively with patients,

As a valued member of the DRG Review Team, the DRG Integrity Specialist performs a secondary level review of medical records and code assignment using knowledge of Accuity technology and client systems with a physician in accordance with federal coding regulations and guidelines as well as client specific coding guidelines to ensure accurate DRG assignment. This function

Utilizes technical coding expertise to assign appropriate ICD 10 CM and ICD 10 PCS codes to inpatient acute care visit types up to 6 days length of stay across all Medical and Surgical service lines.. Complexity is measured by a Case Mix Index (CMI) and Coder I's typically see average CMI's of 1.4 with this mix of the acute care population. This index score demonstrates m

Performs review of the medical record including documentation, reports, flowsheets, and test results, applying evidence based criteria related to DRG and clinical validation denials Creates appeal letters utilizing the relevant information from the medical record; supported by current clinical standards and facility guidelines, evidence based medicine, professionally reco

Day to day operation of library services at Meriter Includes performing literature searches to meet the information needs of Medical Staff members, affiliated clinicians and Meriter staff. Coordinates interlibrary loans, and circulation of library materials. Provide reference services by phone, email, or in person Conduct one on one training with professional staff regard

As a valued member of the DRG Review Team, the DRG Integrity Specialist performs a secondary level review of medical records and code assignment using knowledge of Accuity technology and client systems with a physician in accordance with federal coding regulations and guidelines as well as client specific coding guidelines to ensure accurate DRG assignment. This function

Receive assigned provider inquiries and perform a code review on both professional and facility claims Make determinations on cases after a coding review is complete Review various edits on cases and complete audit of medical records received to ensure proper editing is applied Review medical charts electronically Abstract and code diagnosis and procedures from the medica