Full-Time

DRG Reviewer

Posted on 8/27/2024

Apixio

Apixio

51-200 employees

AI-driven healthcare analytics platform

Compensation Overview

$85k - $105k/yr

Mid

Remote in USA

Category
Healthcare Administration & Support
Medical, Clinical & Veterinary
Requirements
  • Associate or bachelor’s degree in nursing (active/unrestricted license) or Associate or bachelor’s degree in health information management or Work experience may be considered in lieu of formal education at leadership discretion
  • At least one of the following certifications is required: RHIA - Registered Health Information Administrator, RHIT- Registered Health Information Technician, CCDS – Certified Clinical Documentation Specialist, CDIP – Clinical Documentation Improvement Practitioner, CCS - Certified Coding Specialist, CPC-H, Certified Professional Coder-H (Hospital Based), CIC, Certified Inpatient Coder
  • Inpatient claims auditing, quality assurance or recovery auditing experience of 2 years or more required
  • Inpatient Clinical Documentation Integrity experience of 2 years or more required
  • Exhibits high standards for quality and attention to detail
  • Displays deep patterns of curiosity and mastery to understand the root cause of events and behaviors
  • Demonstrated ability to apply critical review judgment to make clinical and/or coding determinations
  • Solid knowledge and understanding of clinical criteria and documentation requirements to successfully substantiate code assignments
  • Subject matter expert in DRG methodologies (e.g., MS & APR)
  • Subject matter expert in ICD-10-CM/PCS coding methodologies, UHDDS definitions, Official Coding Guidelines and AHA’s Coding Clinic Guidelines
  • Demonstrates ability to work efficiently and effectively with minimal direct supervision
Responsibilities
  • Responsible for auditing patient medical records using clinical and coding guideline knowledge along with payer requirements to ensure reimbursement accuracy
  • Provide clear, concise, and compelling rationale and supporting clinical evidence to provider or payer for recommendations or reconsiderations of unsupported billed codes
  • Collaborate with team leaders to ensure DRG denial is thoroughly reviewed
  • Perform all audits in observance of organizational quality and timeliness standards set by the audit operations management team
  • Utilizes proprietary auditing systems and intellectual property with a high level of proficiency to make sound and consistent audit determinations and generate audit letters
  • Makes recommendations for improvements to the audit system that enhance efficiency
  • Assures HIPAA compliance for protected health information
  • Other duties as assigned

Apixio operates in the healthcare analytics field, utilizing artificial intelligence and machine learning to help health plans and healthcare providers make better use of clinical data. The company focuses on automating coding and auditing processes, which are traditionally manual and time-consuming. By using AI, Apixio enhances the efficiency and accuracy of these tasks, allowing healthcare professionals to concentrate on more complex issues. This leads to improved operational efficiency and better patient care. Apixio specializes in risk adjustment, helping health plans predict healthcare costs and optimize funding for their members. Their business model revolves around providing analytic services to clients, who pay to access Apixio's technology. The goal of Apixio is to unlock the potential of healthcare data, improving coding accuracy and overall care delivery.

Company Size

51-200

Company Stage

Series D

Total Funding

$36.1M

Headquarters

San Mateo, California

Founded

2009

Simplify Jobs

Simplify's Take

What believers are saying

  • AI-driven predictive analytics are gaining traction, enhancing Apixio's service offerings.
  • The demand for AI solutions in healthcare is projected to grow significantly by 2026.
  • Apixio's partnership with Vim enhances real-time insights at the point of care.

What critics are saying

  • Integration with existing EHR systems may face resistance from healthcare providers.
  • The healthcare analytics market is becoming increasingly competitive with new entrants.
  • Data privacy and security concerns could lead to regulatory challenges for Apixio.

What makes Apixio unique

  • Apixio uses AI to automate coding and auditing, improving efficiency and accuracy.
  • The company offers centralized patient health profiles for better data-driven insights.
  • Apixio's platform supports risk adjustment and payment integrity for healthcare organizations.

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Benefits

Compensation - Competitive salary, 401k match, and stock options

Health insurance - Exceptional medical, dental, and vision coverage

Career development - Annual stipend for professional events and education

Health & Wellness - Annual stipend for health and wellness programs

Time off - Generous vacation policy, paid holidays, and parental leave

Grub - Catered lunches, healthy snacks, and refreshing drinks

Commuter benefits - Free parking, pre-tax transit benefits, and shuttle service

Events - Team parties, outings, employee recognition, and happy hours

Growth & Insights and Company News

Headcount

6 month growth

32%

1 year growth

32%

2 year growth

32%
Whatech
May 4th, 2024
Healthcare Analytics Market Insights, Forecast to 2031 In The Latest Report

For instance, in August 2022, Apixio launched Apicare ChartSpace, an AI-powered health data management solution that provides real-time access to centralized medical charts, accelerates chart retrieval and audit file access, and facilitates the identification of actionable insights for value-based care programs.

Hit Consultant
Apr 9th, 2024
Apixio Partners With Vim, Bringing Ai Insights To The Point Of Care

What You Should Know:– Apixio, a healthcare data and analytics company, and Vim, a point-of-care connection platform, have joined forces to significantly enhance patient care through a strategic partnership.– The strategic collaboration focuses on improving the accuracy of capturing patient conditions during visits and empowering healthcare providers with real-time insights.The Challenge of Prospective Risk AdjustmentThe healthcare industry is undergoing a critical shift towards prospective risk adjustment models. This approach aims to assess patient health risks more precisely and proactively, allowing for improved care management and financial outcomes. However, seamless integration of these insights into electronic health record (EHR) systems and efficient delivery to clinicians remain significant challenges.Apixio’s Prospective Point-of-Care SolutionThis partnership introduces Apixio’s Prospective Point-of-Care solution, designed to overcome these challenges and exceed traditional EHR alerts. Here’s how it achieves this:AI-powered Insights: Apixio leverages its expertise in extracting valuable insights from both structured and unstructured patient data (including medications, labs, reports, and notes).Apixio leverages its expertise in extracting valuable insights from both structured and unstructured patient data (including medications, labs, reports, and notes). Vim’s Bi-directional EHR Integration: Vim’s advanced technology seamlessly integrates these insights directly into the point-of-care workflow. This ensures up-to-date and accurate diagnoses are captured within the EHR, minimizing administrative burden for clinicians and promoting accurate coding."We're excited with our platform-to-platform partnership with Vim to advance toward an outcomes-based healthcare system

News Journal
Apr 9th, 2024
Apixio Partners With Vim to Deliver AI-Powered Insights at the Point of Care

Apixio partners with Vim to deliver ai-powered insights at the Point of Care.

AiThority
Mar 18th, 2024
Apixio Launches Health Data Nexus, Unifying Health Data with AI-Powered Insights for the Enterprise

With the introduction of Health Data Nexus, Apixio is expanding its health data infrastructure to payers and providers, enabling them to unlock new opportunities for enhancing efficiency and effectiveness across their operations.

PYMNTS
Mar 15th, 2024
$3 Billion Healthtech Merger Aims To Cure Late Payments

New Mountain Capital is reportedly combining three HealthTech firms in a $3 billion deal. The merger is designed to employ artificial intelligence (AI) to help improve payments from health plans to providers, Bloomberg reported Thursday (Sept. 5). According to the report, the deal will bring together three companies from New Mountain’s portfolio: The Rawlings Group, Apixio’s payment-integrity business, and a newly acquired firm called Varis. The combined group is valued at more than $3 billion, sources familiar with the matter told Bloomberg

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