POSITION SUMMARY/RESPONSIBILITIES
Functions under the direct supervision of the Special Investigations Unit (SIU) Manager. Performs at the advanced skill level of a Coding Specialist. Is adept at data collection and statistical report generation. Demonstrates individual judgement, initiates work improvement methods. Will conduct administrative investigations related to fraud and abuse. Will conduct research related to eligibility, claims payment, benefits, prior authorization/referrals and contract review. Responsible for conducting and reviewing audits to assess the quality of coding and documentation to ensure compliance with federal and state laws and regulations. Responsible for researching and compiling documentation that may be reported to external regulatory and law enforcement agencies. Research and audit for accurate provider and facility payments. Identifies overpayments to provider. Assists provider, employee and contractors with the Community First Health Plan's anti-fraud program. Conducts routine education programs for staff and physicians to communicate findings from investigations, coding and documentation audits.
EDUCATION AND EXPERIENCE
High school diploma or its equivalent is required. Five years of experience with ICD-9-CM/DRG assignment, chart auditing, and CPT4 code assignment is required or only two years of experience if candidate has successfully completed a Certified Coding Program or Health Information Management Program. Must be knowledgeable of ICD-10. Must be knowledgeable of Microsoft Office products.
...will change lives. The Engineering SolutionsAccount Executive is accountable for: Responsibilities: Focus within the Oil & Gas and Chemical Manufacturing engineering vertical As an experienced seller in your vertical industry of focus, youll solve our prospects...
...Job Title: Bakery Department Manager Department: Bakery FLSA: Exempt General Function: As a Bakery Department Manager, this position will be responsible for setting the department standards for customer service, employee relations, cleanliness, sanitation...
...Postdoctoral Researcher - Polymer Science Location: CO - Golden | Position Type: Postdoc (Fixed Term) | Hours Per Week: 40 Posting... ...Pay for Equal Work Act, a potential new employees salary history will not be used in compensation decisions. Benefits Summary...
Job Description Growing established Orange County law firm is looking for a talented, hard-working litigation attorney with 1-5 years of experience for its litigation practice. This attorney will be primarily responsible for handling their own case load. Candidates...
Join Lowe's Foods in Wilmington as a full-time Assistant Bakery Manager and become a key player in driving an inviting and engaging bakery experience in alignment with our brand's commitment to freshness and local produce. You will play a pivotal role in leading a team...