3 Aprdrg Jobs

As a Medical Biller / Coder, you will be responsible for overseeing coding activities to ensure customer service and quality expectations are met. You will serve as the primary contact for coding questions related to Client Services and Operations. Your role will involve reviewing reports, identifying specific issues, investigating and correcting them as per the coding guidelines, and implementing solutions. Additionally, you will proactively identify issues and plan for their resolution for clients and accounts. It will be your duty to maintain compliance with HIPAA and ISO standards, as well as adhere to company policies. You will review and report on process updates and team metrics with the management team. Furthermore, you will review provider claims that have not been paid by insurance companies and handle patients" billing queries while updating their account information. To excel in this role, you should have knowledge of Medicare, Medicaid, ICD, and CPT codes used on denials. Understanding the Revenue Cycle Management of US Health Care is essential, along with a good grasp of Denials and the ability to take immediate action to resolve them. You should possess in-depth technical knowledge of ICD-9-CM, ICD-10-CM, CPT and Revenue Codes coding conventions, AP-DRG, APR-DRG, MS-DRG, and APC assignment, present on admission guidelines, secondary diagnoses classification for MCCs/CCs, MDCs, E/M leveling, Medical terminology, anatomy, and physiology. Strong analytical skills are a must for this role, including the ability to manage multiple tasks and create solutions from available information. Your key skills should include E/M, HCPCS, and Medical Coding. The job type is full-time and permanent, with the flexibility of working day, morning, or rotational shifts. This position requires a minimum of 2 years of experience in Medical Coding and a total work experience of 3 years. A valid AAPC certification is required for this role. The industry type is Medical Services / Hospital (Diagnostics), and the department is Healthcare & Life Sciences. The role category is Health Informatics, and the educational requirement is any graduate degree. The preferred location for employment is in Mohali, Punjab, with the ability to reliably commute or plan to relocate before starting work.,

About Us At Zelis India, our mission is to enhance the healthcare financial experience by developing and implementing innovative solutions. We are dedicated to optimizing technology and processes for efficiency and effectiveness. Our collaborative work culture, leadership development initiatives, and global exposure opportunities create a dynamic environment for professional growth. With hybrid work flexibility, comprehensive healthcare benefits, financial wellness programs, and cultural celebrations, we strive to provide a holistic workplace experience. Our team at Zelis India maintains high standards of service delivery and contributes to our award-winning culture. Position Overview As a member of our team, you will be responsible for performing comprehensive inpatient DRG validation Quality Assurance reviews. Your role will involve assessing the accuracy of the DRG billed based on industry standard coding guidelines and clinical evidence provided by the provider. You will implement and conduct quality assurance programs to ensure accurate results for our clients. Additionally, you will manage assigned claims, adhere to client turnaround times and departmental Standard Operating Procedures, and serve as a Subject Matter Expert on DRG validation. Training new team members, identifying new DRG coding concepts, meeting productivity and quality standards, and recommending process improvements are key aspects of this role. Remaining current in national coding guidelines and ensuring adherence to Zelis standards regarding privacy are essential. Travel may be required to meet business needs. Required Qualifications To excel in this role, you should bring: - Preferred Registered Nurse licensure - Required Inpatient Coding Certification (e.g., CCS, CIC, RHIA, RHIT) - 5+ years of experience in reviewing and/or auditing ICD-10 CM, MS-DRG, and APR-DRG claims - Solid understanding of audit techniques, revenue opportunities identification, and financial negotiation with providers - Experience and working knowledge of Health Insurance, Medicare guidelines, and various healthcare programs - Strong understanding of hospital coding and billing rules - Clinical and critical thinking skills for evaluating appropriate coding - Strong organizational skills with attention to detail - Excellent communication skills, both verbal and written - Demonstrated thought leadership, motivation skills, and ability to research and resolve issues Work Environment The role involves a standard work week with the understanding that additional time/effort may be required based on client needs. The work environment is typical for a business setting with moderate noise levels. The ability to lift and move approximately thirty (30) pounds on a non-routine basis and sit for extended periods of time is necessary. Other Details As part of our team, you are expected to embody our culture and values. We offer industry-leading healthcare benefits, caregiving benefits, family forming & reproductive health benefits, mental well-being resources, savings & investments (401K), paid holidays, PTO, educational resources, giving programs, networking opportunities, and discounts on products and services. At Zelis, the well-being of our associates is essential. (Note: This job description is a summary and does not include all the specific job duties and requirements.),

As a Provider Dispute Specialist at our organization, you will play a crucial role in reviewing provider disputes related to DRG Coding and Clinical Validation, Itemized Bill Review, and Clinical Chart Review. Your responsibilities will include submitting explanations of dispute rationale back to providers within the designated timeframe to ensure client turnaround times are met. You will be accountable for managing claim dispute volume on a daily basis, adhering to client turnaround time, and department Standard Operating Procedures. In this role, you will serve as a subject matter expert for the Expert Claim Review Team, providing support on day-to-day activities, troubleshooting, and ensuring data accuracy. Additionally, you will be responsible for creating and presenting educational material to Expert Claim Review Teams and other departments based on dispute findings. Your role will also involve research and analysis of content for bill review, utilizing strong coding and industry knowledge to maintain bill review content. Furthermore, you will be required to stay updated on regulatory changes and compliance enhancements by conducting research from multiple sources. Your support for client-facing teams regarding inquiries related to provider disputes will be crucial. Effective communication and collaboration with various teams within the organization, including the CMO and members of Expert Claim Review Product and Operations teams, will be essential to address important issues and trends. To excel in this role, you should possess a minimum of 5 years of experience in reviewing and/or auditing ICD-10 CM, MS-DRG, and APR-DRG claims. A solid understanding of audit techniques, revenue opportunities identification, and financial negotiation with providers is preferred. Knowledge of Health Insurance, Medicare guidelines, hospital coding and billing rules, and clinical skills for evaluating Medical Record Coding are necessary. In addition to technical skills, you should demonstrate strong analytical, communication, problem-solving, and project management abilities. An active Inpatient Coding Certification (e.g., CCS, CIC, RHIA, RHIT, CPC or equivalent) is required, along with a preference for a Bachelor's Degree in business, healthcare, or technology. Registered Nurse licensure is also preferred. At our organization, we are committed to fostering diversity, equity, inclusion, and belonging. We value the unique perspectives and backgrounds that each individual brings to the table. We encourage candidates from traditionally underrepresented communities to apply, including women, LGBTQIA people, people of color, and people with disabilities. We strive to make our application process accessible to all candidates and provide reasonable accommodations for qualified individuals with disabilities.,