Cassandra Kmak

Review of Inpatient and Outpatient MS-DRG and APR-DRG denials for 1st and 2nd Level appeals. Review in reference to accurate DRG by reviewing coding and clinical documentation to assure accuracy and compliance with documentation rules, coding rules, and any and all coding clinics. Writing Appeal letters and writing review statements as to why claim is or is not appealable. Reviews and contributes comments and information to assist with clinical and coding guideline and support.

Audit of Inpatient MS-DRG and APR-DRG reviews for accuracy of DRG assignment and reimbursement by validating accuracy of ICD-10 CM/PCS code assignments, code sequencing , POA assignment and discharge disposition while also utilizing knowledge of CMS requirements , ICD 10 Official guidelines for Coding and Reporting and AHA Coding clinic guidance. Also audited for clinical coding by reviewing of clinical criteria documentation requirements to successfully substantiate code assignments. Once audited would write accurate and concise rationales in support of findings using ICD 10 CM/PCS Official Coding Guidelines and AHA Coding Clinical. Providing clinical support and expertise to other investigative and analytical departments.Maintained and managed daily case review assignments working remotely.

Audit production team second level reviewers in reference to accurate DRG by reviewing coding and clinical documentation to assure accuracy and compliance with documentation rules, coding rules and any and all coding clinics. Applying as well any client specific directives per contracts. Audited appeals team for accuracy of DRG and accurate coding and clinical support. Train any and all new s for Quality Department . Conducts supervisor duties of running daily meetings and assigning daily work when Supervisor out of office. Conducts and compiles spreadsheet for special projects for specific clients. Reviews and contributes information for out Clinical Policy team who complies job aid to assist with clinical guideline and support for specific Targe DRG's.