Clinical/DRG validation Specialist
3 weeks ago
We are recruiting experienced, certified senior Clinical/DRG Validation Specialists with extensive knowledge of ICD-10-CM and PCS coding, current proficiency in coding clinics, and excellent communication skills.
Qualifications:
Minimum of 2-4 years of experience in
Clinical Validations
and at least 5 years in
Inpatient Facility coding.Education: Life Sciences Graduate or Postgraduate.Credentials: Must possess active AHIMA/AAPC certification(s).Communication: Outstanding verbal and written proficiency in English.Work Location: Must be ready to work from the Hyderabad office.
Responsibilities:
Ability to appeal clinically denied diagnoses using clinical and coding guidelines without missing due dates.Involvement in the clinical denial/appeal process for DRG challenges and clinical validations through Clinical Validation Audits.Reviewing payer denials, determining if an appeal is justified, and writing appeals.Ensuring accurate code assignment by thoroughly understanding coding conventions, guidelines, and updates.Experience in reading and comprehending medical records.Conducting clinical validation by
reviewing physician documentation
to ensure correct codes and sequencing are applied to claims.Accurately depicting the
clinical scenario
within the constructs of the ICD-10-CM/PCS code set.Understanding and validating the appropriateness of services rendered, ensuring that documented conditions meet reportable claims data requirements.
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Clinical/DRG validation Specialist
3 weeks ago
Hyderabad, India DOCTUSUSA INC. Full timeClinical/DRG Validation SpecialistWe are recruiting experienced, certified senior Clinical/DRG Validation Specialists with extensive knowledge of ICD-10-CM and PCS coding, current proficiency in coding clinics, and excellent communication skills.Qualifications:Minimum of 2-4 years of experience in Clinical Validations and at least 5 years in Inpatient...
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Clinical/DRG validation Specialist
3 weeks ago
Hyderabad, India DOCTUSUSA INC. Full timeClinical/DRG Validation SpecialistWe are recruiting experienced, certified senior Clinical/DRG Validation Specialists with extensive knowledge of ICD-10-CM and PCS coding, current proficiency in coding clinics, and excellent communication skills.Qualifications:Minimum of 2-4 years of experience in Clinical Validations and at least 5 years in Inpatient...
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Drg Reviewer-2
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Hyderabad, Telangana, India Zelis Full timePerform comprehensive inpatient DRG validation reviews to determine accuracy of the DRG billed, based on industry standard coding guidelines and the clinical evidence supplied by the provider in the form of medical records such as physician notes, lab tests, images (x-rays etc.), and with due consideration to any applicable medical policies, medical best...
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