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In this role, the DRG/APC Coordinator- Coding Auditor is responsible for ensuring accuracy and quality of coding assignments for all records requiring DRG and/or APC coding; insures optimal and timely reimbursement.
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The Professional Coding Auditor performs reviews for professional/clinic based clinic visits and hospital setting claims reviewing provider's diagnosis and procedural coded claims in ensuring coded data is in compliance with Official Coding Guidelines and American Medical Association CPT/HCPCS procedural coding conventions.
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Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10- CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines.
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An Appeals Nurse Coordinator II will have experience with utilization management, DRG clinical validation, understand the state and federal regulations, have knowledge/experience with the denials and appeals process and have experience with physician documentation and electronic health records.
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Must possess and maintain one of the following national coding certifications: Radiology Certified Coder (RCC) or Certified Professional Coder (CPC) or Certified Professional Coder Apprentice (CPC - A) or Registered Records Administrator (RRA) or Accredited Record Technician (ART) or Certified Coding Specialist-Physician (CCS-P.
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Collaborates with staff/departments, including, but not limited to: Executive Management, Resource Management, Medical Records, Patient Administration, Group Practice Managers, Health Care Integrators, Coders/Coding Auditors, Population Health Nurse Consultants, Medical Management, Referral Management, TRICARE Operations, patient care teams, Quality Improvement, and the Managed Care Support Contractors.
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The Senior Physician Compliance Auditor is responsible for reviewing and auditing claims, medical records, and charges to ensure compliance with applicable documentation, coding, and billing requirements.
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One to three years progressive ICD-10 and CPT coding of hospital inpatient medical records of various complexity or 2 years minimum Clinical nursing in an acute care setting with knowledge of ICD-10 coding.
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An Ophthalmic Technician role may combine skills of a medical office administrator, medical billing and collections, appointment scheduler or medical records clerk and direct patient care. Optometric medical billing and coding.
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ESSENTIAL DUTIES AND RESPONSIBILITIES: Conduct compliance coding reviews of medical records and supporting documentation against submitted claims, to determine coding and billing accuracy for medical, dental, mental health services, including telehealth and telemedicine services.
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Excellent working knowledge of electronic medical records, medical terminology, ICD-10, CPTII coding, and medical coding and billing processes. The programs the AVP will have oversight for include but are not limited to: MACRA/MIPS, 21st Century CURES, Centers for Medicare and Medicaid Innovation (CMMI) projects; Accountable Care Organizations (ACO); Advanced Alternative Payment Models (AAPM); Medicare Advantage; and commercial payer value programs.
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This position is responsible for ICD-10 Coding and OASIS Review, quality assurance, accuracy and overall integrity of the clinical records and documentation completed by Clinical staff. OASIS Certification and ICD-10 Coding Certification, preferred.
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Concurrent reviews assure the completeness of medical records, the accuracy of documentation, and the appropriate assignment of a final DRG. The CDI Specialist functions as a resource for clinical staff and other groups involved in the care and discharge planning of patients.
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Accurately code and abstract outpatient medical records for reimbursement and statistical purposes using established coding guidelines. Code all outpatient medical records in a timely and accurate manner.
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An Optometric Office Technician role may combine skills of a medical office administrator, medical billing and collections, appointment scheduler or medical records clerk and direct patient care.
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