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

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

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

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

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

At Children's Wisconsin, we believe kids deserve the best. Children's Wisconsin is a nationally recognized health system dedicated solely to the health and well being of children. We provide primary care, specialty care, urgent care, emergency care, community health services, foster and adoption services, child and family counseling, child advocacy services and family res

Utilizes technical coding expertise to assign appropriate ICD 10 CM and ICD 10 PCS codes to complex inpatient visit types. Complexity is measured by a Case Mix Index (CMI) and Coder II's typically see average CMI's of 2.2609. This index score demonstrates higher patient complexity and acuity. Utilizes expertise in clinical disease process and documentation, to assign Pres

Utilizes technical coding expertise to assign appropriate ICD 10 CM and ICD 10 PCS codes to complex inpatient visit types. Complexity is measured by a Case Mix Index (CMI) and Coder II's typically see average CMI's of 2.2609. This index score demonstrates higher patient complexity and acuity. Utilizes expertise in clinical disease process and documentation, to assign Pres

Utilizes technical coding expertise to assign appropriate ICD 10 CM and ICD 10 PCS codes to complex inpatient visit types. Complexity is measured by a Case Mix Index (CMI) and Coder II's typically see average CMI's of 2.2609. This index score demonstrates higher patient complexity and acuity. Utilizes expertise in clinical disease process and documentation, to assign Pres

Develops curriculum and materials for documentation training programs. Assesses coder comprehension. Conducts quality assurance reviews. Reviews, researches, and responds to coding questions. Resolves coding questions from patient inquiries or denied services from insurance companies. Performs focused quality assurance reviews on coded services. Communicates updates on co