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Establishes and documents, based on the predicted DRG and multidisciplinary team member's input, Anticipated Date of Transition (ADOT) and destination and updates, as needed. The RN Care Manager is knowledgeable of post-hospital care and services available to the patient including, but not limited to the following: Home Health, Infusion Services, Durable Medical Equipment, Palliative Care, Hospice, Outpatient Services, Transitions of Care Clinics, Transitional Care supportive programs and clinics, follow up appointments, Skilled Nursing Facilities, Rehabilitation Services and Facilities and Community-based Organizations.
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Or similar”) Willingness to learn medical terminology, medical coding systems; ICD-10, CPT4, DRG, GPI. Familiarity with software development, data, and integration architecture Hours/Location: M-F; Days May work remotely but will prefer local applicants for occasional onsite needs.
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Maintains expert knowledge of all coding and classification systems used in health care (ICD, CPT, DRG, CMG, APC, and ASC), key information that impacts reimbursement and statistical reporting systems, and the clinical information requirements of both accreditation and licensing agencies.
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Is a division of Davey Resource Group Inc. (DRG) which has been employee-owned since 1979. DRG specializes in managing the assets of utility companies throughout the U.S. by providing solutions, focused around the electrical and telecommunication industries.
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ICD-, CPT, HCPCS, DRG, APC, ASC, SNOMED CT, EDI implementation guides, etc. ICD-, CPT, HCPCS, DRG, APC, ASC, SNOMED CT, EDI implementation guides, etc. Responsibilities: Serves as Data Steward dedicated to health care payer Claims data operations & initiatives Works collaboratively with other enterprise and business data stewards to align standards and share best practices; represents Claims data domain in enterprise workgroups and data steward communities of practice Leads Data Governance initiatives and collaborations with business and IT operational stakeholders to: ○ Document, define, maintain, and manage data standards and assets.
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Calculates and determines appropriate DRG#s for inpatient medical records and calculates appropriate APC#s for outpatient and ED records utilizing computerized grouper in accordance with department guidelines ensuring optimal third-party payor reimbursement.
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The scope of responsibility includes professional nursing care coordination practice, human resource management, educational development, research, continuous improvement, utilization management, DRG program and MGB, Brigham (BWH and BWFH) network initiatives.
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Provides assessment and reporting interventions in child abuse/neglect, domestic violence, adult/elderly abuse, child protection, sexual assault, and human trafficking as appropriate. The Social Work Care Manager is knowledgeable of post-hospital care and services available to the patient including, but not limited to the following: Home Health, Infusion Services, Durable Medical Equipment, Palliative Care, Hospice, Outpatient Services, Transitions of Care Clinics, Transitional Care supportive programs and clinics, follow up appointments, Skilled Nursing Facilities, Rehabilitation Services and Facilities and Community-based Organizations.
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To be successful in this position, the CDI Specialist must be able to: Complete initial medical record reviews of patient records within 24-48 hours of admission for specified patient population to (a) evaluate documentation to assign the principal diagnosis, pertinent secondary diagnosis, and procedures for accurate DRG assignment, risk of mortality and severity of illness, and (b) initiate a review sheet.
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Exhibits expert knowledge of clinical documentation requirements, MS-DRG Assignment, case mix index (CMI) analysis, clinical disease classifications, major and non-major complications and comorbidities (MCCs or CCs), and quality-driven patient outcome indicators.
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Audits, codes, and abstracts diagnostic and procedural information and assigns optimal diagnostic related group (MS-DRG or APC). Actively seek to obtain certification with American Health Information Management Association (AHIMA) as a Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or Certified Coding Specialist (CCS) and/or Registration with American Association of Professional Coders (AAPC) as a Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Inpatient Coder (CIC) or other equivalent coding certification.
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Identifies and assigns principal diagnosis and procedure codes, sequencing them as needed for proper Ambulatory Payment Classification (APC), Medicare Severity-Drug Related Group (MS-DRG), All Patients Refined Diagnosis Related Groups (APR-DRG) assignment, utilizing applicable coding conventions.
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Working knowledge of coding conventions, including DRG and ICD10 coding. The CDI Specialist will also perform focused reviews as directed by the department supervisor. The CDI Specialist communicates with physicians, clinicians, Coding and HIM professionals, nursing staff and Care Management to ensure timely and accurate documentation and provides training and education as needed.
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And healthcare payment and coding methodologies (i.e. ICD-9, CPT, DRG and HCC coding) Martin’s Point also administers two health plans: Generations Advantage (Medicare Advantage plans available throughout Maine and New Hampshire), and the US Family Health Plan (TRICARE Prime® plan for active-duty and retired military families in northern New England, upstate New York, and western Pennsylvania.
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Evaluates the appropriateness of ICD-10, HCPCS and CPT codes, APC/EAPG, DRG, and admission assignments, along with modifier usage. Description The Coding Auditor demonstrates expertise in coding and billing compliance while performing audits to determine billing integrity of professional and facility/technical fees including detection and correction of documentation, coding and billing errors and/or medical necessity of services billed.
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