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Exhibits a sufficient knowledge of clinical documentation requirements, MS-DRG Assignment, and clinical conditions or procedures, Educates members of the patient care team regarding documentation guidelines, including attending physicians, allied health practitioners, nursing, and case management.
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Knowledge of Ambulatory Payment Classifications (APC), Diagnosis Related Group (DRG) and Fee-For-Service (FFS) reimbursement methodologies preferred. Knowledge of Ambulatory Payment Classifications (APC), Diagnosis Related Group (DRG) and Fee-For-Service (FFS) reimbursement methodologies preferred.
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Housed in Denver, DRG brings together some of the country's best-known brands, leveraging an industry-leading platform with a clear vision for continued growth. Dividend Restaurant Group (DRG) was built on the core belief that the foundation of a company is defined by the character of the team, the versatility of its systems and the discipline of its actions.
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Record Review: Completes initial medical records reviews of patient records within 24-48 hours of admission for a specified patient population to: (a) evaluate documentation to assign the principal diagnosis, pertinent secondary diagnoses, and procedures for accurate MS-DRG assignment, risk of mortality and severity of illness; and (b) initiate a review worksheet.
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The Appeals and Denials Specialist is responsible for triaging and writing DRG downgrades and clinical validation appeal letters for multiple clients. Performs review of the medical record including documentation, reports, flowsheets, and test results, applying evidence-based criteria related to DRG and clinical validation denials.
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