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Provides second-level reviews of clinical documentation of concurrent and retrospective documentation as it relates to Patient Safety Indicators (PSI), Hospital Acquired Conditions (HAC), payer denials, working DRG and final DRG mismatches, mortality reviews, and other appropriate second-levels. SUMMARY: Works with physicians, HIM (Health Information Management), Clinical Documentation Integrity (CDI) team members, ancillary staff, and multidisciplinary team members to improve the quality, and completeness of documentation of the patient's clinical condition and treatment provided for designated populations.

Tucson Medical Center

RN Clinical Documentation Integrity Second-Level Reviewer

This is accomplished by leveraging a deep understanding of Oscar's claim infrastructure, workflows, workflow tooling, platform logic, data models, etc., to work cross-functionally to understand and translate friction from stakeholders into actionable opportunities for improvement. Proactively identify and document potential billing errors, including duplicate billing of items, services, or procedures as improper unbundling of services (e.g., separating components that should be billed together) and charges for non-covered or non-rendered services.

Medical Coder Jobs in Phoenix, AZ

RN Clinical Documentation Integrity Second-Level Reviewer Tucson Medical Center

Itemized Bill Reviewer Oscar Health Insurance

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