The DRG Validation Nurse Reviewer will be primarily responsible for conducting post service, pre payment and post pay comprehensive inpatient DRG reviews based on industry standard inpatient coding guidelines and rules, evidence based clinical criteria plan, and policy exclusions. Conduct reviews on inpatient DRG claims as they compare with medical records ICD 10 Official

The Certified Edit Dispute Resolution Analyst will be responsible for researching and auditing medical records for complex, diverse, multi specialty provider claims to identify and determine appropriately coded billed services when compared to the Zelis Claim Edits Product. The Certified Edit Dispute Resolution Analyst demonstrates an understanding of Zelis edits as an in

At Boston Children's Hospital, the quality of our care and our inclusive hospital working environment lies in the diversity of our people. With patients from local communities and 160 countries around the world, we're committed to reflecting the spectrum of their cultures, while opening doors of opportunity for our team. Here, different talents pursue common goals. Voices

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

Clinical Documentation Specialist Job Ref 29018 Category Professional & Management Location Emerson Hospital, 133 Old Road to Nine Acre Corner, Concord, MA 01742 Department Medical Records Schedule Full Time Shift Day shift Hours 730 4 Reporting to the Director of Medical Records the Clinical Documentation Specialists facilitates improvement in the overall quality, comple

SPG Admin Coding Fairhaven , MA Admin/Clerical Support Pay Grade SC020 Full time , Day shift , 40 Req # 78988 Work for One of the World's Best Hospitals! For Five Consecutive Years, Newsweek named Southcoast Health among the World's Best Hospitals (Charlton Memorial, St. Luke's, and Tobey). In addition, since 2018, Southcoast Health has been voted by readers as South Coas

At Boston Children's Hospital, the quality of our care and our inclusive hospital working environment lies in the diversity of our people. With patients from local communities and 160 countries around the world, we're committed to reflecting the spectrum of their cultures, while opening doors of opportunity for our team. Here, different talents pursue common goals. Voices

SPG Admin Billing Fairhaven , MA Admin/Clerical Support Pay Grade SC019 , Day shift , 24 Req # 77009 Work for One of the World's Best Hospitals! For Five Consecutive Years, Newsweek named Southcoast Health among the World's Best Hospitals (Charlton Memorial, St. Luke's, and Tobey). In addition, since 2018, Southcoast Health has been voted by readers as South Coast Media G

This position is responsible for the accurate and complete collection and capture of patient registration data for inpatients, observation, and day surgery patients. Reviews and confirms that valid insurance coverage exists for each admission and collects other important demographic and statistical information on all patients. Updates all data in the Siemens Invision syst

Weekdays, 1st shift! No nights, weekends or holidays ever! General Description Responsible for maintaining the security of confidential patient information, while maintaining organization of an integrated chart system including the filing, copying and distribution of records. The Medical Records Keeper also assists with general clerical duties. Qualifications HS Diploma/G

Payer Enrollment Specialist Per Diem Job Ref 29117 Category Professional & Management Location Emerson Hospital, 133 Old Road to Nine Acre Corner, Concord, MA 01742 Department Managed Care Schedule Per Diem Shift Day shift Hours 8 30am 5 00pm Job Summary Under general supervision and co reporting to the Director of Physician Practice Billing and Executive Director of Reve

SC Rehab Services Admin New Bedford , MA Admin/Clerical Support Pay Grade SC012 Part time , Day shift , 32 Req # 77690 Work for One of the World's Best Health Systems! For Five Consecutive Years, Newsweek named Southcoast Health among the World's Best Hospitals (Charlton Memorial, St. Luke's, and Tobey). In addition, since 2018, Southcoast Health has been voted by readers

Ensures CXM's data management activities are fully compliant with all regulatory requirements Other duties as assigned What We're Looking For Education Required BA/BS in a related field Education Desired BA/BS in a related field with strong emphasis in data analysis. Experience Required A minimum of 3 5 years of relevant work experience (i.e., data analytics informatics,

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

Upon review of the medical record, performs analysis on documentation, which includes review of tests / reports to determine the appropriate ICD CM (current edition) and / or CPT codes as well as modifiers. Based on account type, may assign ICD PCS codes, as defined by official coding guidelines and other recognized reference materials. Verifies documentation is present t