
USRN with Medical coding experience
1 week ago
Job Profile Summary:
Responsible for auditing inpatient medical records to ensure clinical documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims.
Primary duties may include, but are not limited to:
- Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities.
- Draws on advanced ICD-10 coding expertise, mastery of clinical guidelines, and industry knowledge to substantiate conclusions.
- Utilizes audit tools, auditing workflow systems and reference information to generate audit determinations and formulate detailed audit findings letters.
- Maintains accuracy and quality standards as established by audit management. Identifies potential documentation and coding errors by recognizing aberrant coding and documentation patterns such as inappropriate billing for readmissions, inpatient admission status, and Hospital-Acquired Conditions (HACs).
- Suggests and develops high quality, high value, concept and or process improvement and efficiency recommendations.
- Requires current, active, unrestricted Registered Nurse license in applicable state(s) and minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and a minimum of 5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG.
One or more of the following certifications are preferred:
Certified Clinical Documentation Specialist (CCDS),
- Certified Documentation Improvement Practitioner (CDIP),
- Certified Professional Coder (CPC) or Inpatient Coding Credential such as CCS or CIC.
- Experience with third party DRG Coding and/or Clinical Validation Audits or hospital clinical documentation improvement experience preferred.
- Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing guidelines, payer reimbursement policies, and coding terminology preferred.
-
usrn
2 weeks ago
Manila, National Capital Region, Philippines Nezda Global Full timeOverviewNezda Technologies Inc. is currently looking for USRN.You may earn up to P 68,000 and get a chance to have P 100,000 Sign on Bonus.QualificationsActive PHRN and USRN License (mainland state).At least 1 year hospital experience.Job DescriptionConduct Non-Clinical Research to Support Determinations.Determine that the case is assigned to the appropriate...
-
Clinical Nurse Case Manager – USRN
2 weeks ago
Manila, National Capital Region, Philippines Nezda Global Full timeOverviewNezda Technologies Inc. is currently hiring for Clinical Nurse Case Manager - USRN.Salary: P 50,000 - P 68,000 (with Perks and benefits).Work Set up: Work From HomeThis position is offered through partnerships with multiple companies; you have an option to choose the company that fits you best. This is a direct employment opportunity with no...
-
Medical Professionals
2 weeks ago
Manila, National Capital Region, Philippines Stark Asia Solutions Inc. Full time ₱32,000 - ₱65,000 per yearWe Are Hiring Build Your Healthcare Career With UsWe are expanding our healthcare team and looking for skilled and passionate professionals to join us. Explore the exciting opportunities below:Position: Certified Medical CoderLocation: Metro Manila. DavaoQualifications:Active CPC/CPC-AWith or Without coding experienceSalary and Benefits:25,000 to 32,000 +...
-
Manila, National Capital Region, Philippines Nezda Technologies, Inc. Full time ₱80,000 per yearWe're looking for skilled Utilization Review Nurses (PHRN-USRN) to join our dynamic team and ensure medical necessity, cost-efficiency, and compliance with health plan policies and regulatory standards. QualificationsMust have active PHRN or USRN licenseMust have 1 year of experience in utilization review in a healthcare BPO set upExcellent verbal and...
-
Medical Coding Specialist
7 days ago
Manila, National Capital Region, Philippines beBeeHealthcare Full time ₱80,000 - ₱150,000Certified Medical CoderTranslate doctor's notes and medical records into universal codes used by insurance companies and healthcare systems. Ensure accurate billing and provider payment. Utilize knowledge of medical terms and guidelines for precise coding.Responsibilities:Translate medical records into standard codesVerify accuracy of coding to ensure...
-
Medical Coding Specialist
6 days ago
Manila, National Capital Region, Philippines beBeeCoding Full time $50,000 - $70,000Medical Coding Specialist Job DescriptionThe Medical Coding Specialist is responsible for reviewing patient records and assigning relevant diagnosis and procedure codes using established coding classification systems. This role plays a vital part in the healthcare industry by ensuring accurate coding that meets regulatory standards.Patient Populations: The...
-
Medical Coding Specialist
7 days ago
Manila, National Capital Region, Philippines beBeeCoding Full time ₱550,000 - ₱850,000Risk Adjustment Coding OpportunityWe are seeking a highly skilled Medical Coding Specialist to review medical records, identify diagnoses, and validate risk adjustment models.This role involves analyzing medical records to assign accurate ICD-10-CM codes according to risk adjustment guidelines. The ideal candidate will have strong knowledge of ICD-10-CM...
-
Medical Coding Educator
7 days ago
Manila, National Capital Region, Philippines beBeeCoding Full time ₱59,274 - ₱80,890Job Overview:As a Medical Coding Educator, you will be responsible for creating and delivering medical coding education programs to ensure the accuracy and efficiency of medical coding practices.Key Responsibilities:Design and implement curriculum and training materials for new and existing medical codersStay up-to-date on ICD 10 CM, CPT, E/M coding,...
-
Medical Coding Educator
6 days ago
Manila, National Capital Region, Philippines beBeeMedicine Full time ₱600,000 - ₱1,000,000Medical Coding Education SpecialistWe are seeking a skilled Medical Coding Education Specialist to join our team. As a key member of our coding department, you will be responsible for conducting medical coding education for new and existing medical coders.This is an exciting opportunity to leverage your knowledge of ICD 10 CM, ICD 10 PCS, CPT, and HCPCS...
-
Medical Coding Expert
1 week ago
Manila, National Capital Region, Philippines beBeeAuditor Full time ₱550,000 - ₱750,000Job DescriptionWe are seeking a detail-oriented Coding Auditor to join our team. As a Coding Auditor, you will play a critical role in ensuring the accuracy and compliance of medical coding practices.The Coding Auditor will be responsible for conducting thorough reviews of medical documentation and coding to ensure that it meets regulatory standards. You...