Job description:
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- Reviews prepay claims with corresponding medical records to determine payment accuracy
- Reviews applicable policies, CPT guidelines and contracts as they pertain to clinical review
- Participates in regulatory meetings with client
- Participates in meetings with providers, advocates and legal to assist with provider abrasion
- Performs additional projects as needed by the business or Client; analyzes data; meets with internal and external stakeholders as necessary for resolution
- Continuous monitoring of claim inventory in order to adhere to performance guarantees
- Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so
