Serves customers by answering incoming calls utilizing Denver Health and Departmental policies/processes to resolve customer health information requests and directing calls to the appropriate area when necessary.
Provides assistance to Denver Health staff by collecting demographic, medical complaint and key information required to facilitate appropriate patient care and call resolution.
Educates customers on additional services by recognizing opportunities to enhance the customers' experience and meet their needs.
Support attorneys by reviewing claim files, compiling factual summaries, identifying key documents and facilitating legal analysis regarding liability, potential defenses, exposure valuations, and settlement strategies. Review and analyze health care claim files involved in payor/provider disputes, identifying patterns and administrative issues. Evaluate merits and potential liability of claim batches to assess applicability to claims in dispute.
The DRG Validator/Reviewer is responsible for reviewing post-billed inpatient claims to identify and validate missed reimbursement opportunities based on diagnosis and procedure coding. Working within a specialized DRG (Diagnosis-Related Group) database and utilizing their technical expertise in ICD-10 coding to analyze medical records, determine coding accuracy, and make recommendations that optimize hospital reimbursement.
Shape the future of trans healthcare by serving as the clinical voice and subject matter expert, engaging with both internal and external stakeholders. Your role will be critical in advocating for the clinical experience during product launches, ensuring clinical accuracy in public-facing content, and leading the development and updates of key internal medical processes.