ProgenyHealth LLC
Plymouth Meeting, PA, USA
Job Description Job Description Description: Job Role The Clinical RN Chart Reviewer will perform clinical reviews of medical records and other documentation to validate issues of claims coding accuracy, medical necessity, and the appropriateness of treatment settings and services delivered. The Clinical RN Chart Reviewer will report to the Payment Assurance Manager and support a culture and work environment that promotes and inspires an active, continuous improvement philosophy regarding products and services in line with our company mission. This role requires certified coding expertise and a strong understanding of DRG validation, medical necessity, and regulatory guidelines. Requirements: Responsibilities will include: · Audits and analyzes neonatal intensive care unit (NICU) claims according to ICD-10 coding principles and clinical guidelines. · Analysis of claims data to optimize reimbursement by ensuring that the diagnosis codes, procedure codes, and supporting...