Team & Operations Management: Supervise and manage the daily activities of the surgery coding and audit teams, including in-house and contract auditors. Allocate workload, monitor performance, and ensure timely completion of assigned tasks in alignment with project timelines.
Conduct comprehensive reviews of inpatient medical records to validate that assigned ICD-10-CM/PCS codes and DRG classifications accurately reflect the documented clinical conditions and procedures. Ensure compliance with IPPS (Inpatient Prospective Payment System) methodology, CMS guidelines,
Conduct comprehensive reviews of inpatient medical records to validate that assigned ICD-10-CM/PCS codes and DRG classifications accurately reflect the documented clinical conditions and procedures. Ensure compliance with IPPS (Inpatient Prospective Payment System) methodology, CMS guidelines,
Conduct comprehensive reviews of inpatient medical records to validate that assigned ICD-10-CM/PCS codes and DRG classifications accurately reflect the documented clinical conditions and procedures. Ensure compliance with IPPS (Inpatient Prospective Payment System) methodology, CMS guidelines,
Skills Required Strong analytical and critical-thinking skills Excellent medical record review and interpretation skills Effective written and verbal communication Ability to work independently and manage multiple priorities Knowledge of denial management and appeals processes Strong problem-solving and
1. Coding Audit and Review Conduct detailed DRG validation audits on selected inpatient medical records to ensure coding accuracy, completeness, and compliance with ICD-10-CM/PCS, AHA Coding Clinic, and CMS guidelines. Review documentation to confirm that all reported diagnoses and procedures
Conduct comprehensive reviews of inpatient medical records to validate that assigned ICD-10-CM/PCS codes and DRG classifications accurately reflect the documented clinical conditions and procedures. Ensure compliance with IPPS (Inpatient Prospective Payment System) methodology, CMS guidelines,
Review and audit medical claims against patient medical records to ensure accuracy and completeness of documentation. Identify discrepancies between clinical documentation and billed services, highlighting variances and potential billing errors. Perform detailed clinical reviews to validate diagnosis, procedures,
Medical Coding Team Lead – Surgery & Payment Integrity is responsible for overseeing a team of medical coding specialists to ensure accurate, compliant, and timely auditing of surgical procedures across multiple specialties. This role demands strong technical expertise in CPT,
3+years of experience after certification is must Perform detailed quality audits of coded medical records to ensure accuracy, compliance, and adherence to official coding guidelines and payer-specific requirements. Review and analyze clinical documentation for completeness and accuracy in
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the
Opportunity Overview: We are seeking a highly analytical, detail-oriented, and results-driven Data Analyst to join our dynamic Payment Integrity team. This role is critical in transforming complex healthcare claims, provider, operational, and financial data into actionable
Opportunity Overview: We are seeking a highly analytical, detail-oriented, and results-driven Data Analyst to join our dynamic Payment Integrity team. This role is critical in transforming complex healthcare claims, provider, operational, and financial data into actionable
Opportunity Overview: We are seeking a highly analytical, detail-oriented, and results-driven Data Analyst to join our dynamic Payment Integrity team. This role is critical in transforming complex healthcare claims, provider, operational, and financial data into actionable
Overview: The SENIOR EXECUTIVE CODING AUDITOR performs reviews, analyzes, and codes documentation from medical records that determines payments. This position performs highly technical and specialized functions, and the primary function of this position is to perform a thorough review
Training Program Management: Design, develop, and implement training strategies and programs tailored to surgery coding and coding audit teams. Conduct strategic needs analyses to identify skill gaps and develop training plans that address these gaps effectively. Develop comprehensive
Key Responsibilities • Continuous Integration & Delivery: Design, maintain, and enhance CI/CD pipelines to build, test, and deploy software across multiple environments. Ensure build failures are promptly investigated and fixed, collaborating with development teams to maintain
We are the leading provider of professional services to the middle market globally, our purpose is to instill confidence in a world of change, empowering our clients and people to realize their full potential. Our exceptional
We are the leading provider of professional services to the middle market globally, our purpose is to instill confidence in a world of change, empowering our clients and people to realize their full potential. Our exceptional
Job Summary • Risk Reporting and Service Delivery Unit faces the Group Risk Function with a peripheral support to CEO CIB Function. It handles wide spectrum of activities to support the Enterprise Risk Analytics, Traded Risk