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

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

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

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

Extrapolate data from source records into case report forms for all patient visits. Ensure timely data submission in accordance with USOR SOPs. Responsible for resolving queries, communicating concerns or questions about data to clinical staff and or research management. Utilizes USOR clinical trial management system to access research forms and keep current all applicabl

Review pre bill cases simultaneously with a physician during each work shift excluding breaks and meetings to analyze and validate diagnosis and procedure codes for inpatient services via coding compliance and clinical knowledge to support accurate DRG assignment Utilizes Accuity technology for tracking of coding errors, query opportunities and other data collection as ne

General information Name Core Healthcare Consultant Healthcare Reimbursement Posting Title Healthcare Reimbursement Consultant Ref # 2232066 Date Published Thursday, March 21, 2024 City Wichita State Kansas Country United States Job Category Other Consulting Services Department Consulting Office Wichita KS Advertised Location US KS Wichita Working time Full Time Descripti

Assess the clinical indicators and suggestions of various query requests received from the MD Reviewer/ DRG Integrity Specialist Collaborate and communicate as necessary to clarify and avoid misinterpretation to ensure the query is optimally written and distributed to the correct client provider Creates queries in a compliant manner in accordance with AHIMA and ACDIS comp

Essential functions Provides appropriate CPT and ICD 10 codes for professional services and office procedures, focusing on Evaluation and Management encounters and pain management procedures. Provides assistance to providers with coding updates and/or changes and education. Assists billing office staff in a timely manner with coding related denials, questions, and educati

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